相关实验视频

Updated: May 6, 2026

A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients

A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients

Published on: October 17, 2017

在儿科创伤性脑损伤中,动态与固定脑 perfusion 压力目标:一个 STARSHIP 分析

C A Smith¹, S Y Bögli^1,2, M M Placek¹

¹Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.

EClinicalMedicine

|July 29, 2025

概括

在儿童创伤性脑损伤 (TBI) 中,监测自调的下限 (LLA) 是至关重要的. 较高的LLA值与较差的结果相关,这表明目前的固定脑输液压 (CPP) 目标可能不足.

科学领域:

儿科重症监护室的儿童重症监护室
神经临界护理是指神经临界护理.
创伤性脑损伤管理

背景情况:

大脑输液压 (CPP) 对于治疗儿科创伤性脑损伤 (TBI) 至关重要.
目前的指导方针建议CPP目标为40-50mmHg,但承认基于年龄和自我调节的变化.
考虑到脑血管自我调节状态,可能需要个性化CPP目标.

研究的目的:

将固定的CPP目标与基于自我监管的目标进行比较 (CPPopt和自主监管的下限 - LLA).
调查自动调节基目标以下的时间与儿科TBI患者的治疗结果之间的关联.
评估与患者结果相关的LLA的动态行为.

主要方法:

对前性多中心STARSHIP研究 (135名TBI儿童) 的二次分析.
持续对CPP,CPPopt和LLA进行分分钟评估.
使用单变量和多变量分析,比较低于固定的CPP目标的剂量和百分比时间,与基于自我调节的目标相比.
在临床试验.gov注册:NCT0688462.

主要成果:

每小时剂量和低于LLA的百分比时间都与较差的结果独立相关 (分别为p=0.017和p=0.008).
LLA显示出一个动态的趋势,随着时间的推移,在不良结果的患者中增加 (p=0.003).
在总体监测时间的45%以上,LLA超过50mmHg,在0-2岁队列中超过35%.

结论:

动态自调节监测,特别是LLA,与儿科TBI的结果有关.
在不良结果的患者中观察到较高的LLA值.
目前的固定CPP值 (40-50 mmHg) 可能过低,需要进一步研究自主监管引导的CPP目标以实现个性化管理.

关键词:

大脑输液压的压力大脑输液压.大脑血管自身调节密集护理管理管理密集护理管理多模式神经监测多模式神经监测儿童创伤性脑损伤

更多相关视频

Effects of Blast-induced Neurotrauma on Pressurized Rodent Middle Cerebral Arteries

Effects of Blast-induced Neurotrauma on Pressurized Rodent Middle Cerebral Arteries

Published on: April 1, 2019

A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury

A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury

Published on: March 26, 2019

相关概念视频

Increased Intracranial Pressure l: Introduction

Increased Intracranial Pressure l: Introduction

Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component...

Increased Intracranial Pressure ll: Pathophysiology

Increased Intracranial Pressure ll: Pathophysiology

Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins...