PDF(Pubmed)
Abstract：
Cerebrovascular pressure reactivity plays a key role in maintaining constant cerebral blood flow. Unfortunately, this mechanism is often impaired in acute traumatic neural injury states, exposing the already injured brain to further pressure-passive insults. While there has been much work on the association between impaired cerebrovascular reactivity following moderate/severe traumatic brain injury (TBI) and worse long-term outcomes, there is yet to be a comprehensive review on the association between cerebrovascular pressure reactivity and intracranial pressure (ICP) extremes. Therefore, we conducted a systematic review of the literature for all studies presenting a quantifiable statistical association between a continuous measure of cerebrovascular pressure reactivity and ICP in a human TBI cohort. The methodology described in the Cochrane Handbook for Systematic Reviews was used. BIOSIS, Cochrane Library, EMBASE, Global Health, MEDLINE, and SCOPUS were all searched from their inceptions to March of 2023 for relevant articles. Full-length original works with a sample size of ≥10 patients with moderate/severe TBI were included in this review. Data were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A total of 16 articles were included in this review. Studies varied in population characteristics and statistical tests used. Five studies looked at transcranial Doppler-based indices and 13 looked at ICP-based indices. All but two studies were able to present a statistically significant association between cerebrovascular pressure reactivity and ICP. Based on the findings of this review, impaired reactivity seems to be associated with elevated ICP and reduced ICP waveform complexity. This relationship may allow for the calculation of patient-specific ICP thresholds, past which cerebrovascular reactivity becomes persistently deranged. However, further work is required to better understand this relationship and improve algorithmic derivation of such individualized ICP thresholds.
摘要：
脑血管压力反应性在维持恒定的脑血流量中起关键作用。不幸的是,这种机制通常在急性创伤性神经损伤状态下受损，将已经受伤的大脑暴露于进一步的压力被动侮辱。虽然在中度/重度创伤性脑损伤（TBI）后脑血管反应性受损与长期预后不良之间的关系方面已有大量工作，脑血管压反应性与颅内压(ICP)极值之间的相关性尚待全面审查.因此,我们对所有研究的文献进行了系统回顾,这些研究在连续测量的脑血管压反应性与人TBI队列中ICP之间存在可量化的统计学关联.使用了Cochrane系统评价手册中描述的方法。BIOSIS,科克伦图书馆,EMBASE,全球卫生,MEDLINE,和SCOPUS都从他们的开始到2023年3月进行了相关文章的搜索。本综述包括样本量≥10例中度/重度TBI患者的全长原创作品。根据系统评价和荟萃分析的首选报告项目报告数据。本综述共包括16篇文章。研究的人口特征和使用的统计检验各不相同。5项研究基于经颅多普勒指数，13项研究基于ICP指数。除两项研究外，所有研究均能够显示脑血管压力反应性与ICP之间的统计学显着关联。根据这篇综述的结果，受损的反应性似乎与ICP升高和ICP波形复杂性降低有关。这种关系可以允许计算患者特定的ICP阈值。过去脑血管反应性持续紊乱。然而,需要进一步的工作来更好地理解这种关系,并改进此类个体化ICP阈值的算法推导.
