JAMA Neurol:创伤性脑损伤后缺血及血管功能异常的时空变化规律

2019-11-18 MedSci MedSci原创

研究认为缺血是常见的创伤性脑损伤早期症状,部分患者无颅内高血压,并且颈静脉或脑组织氧饱和度存在差异。TBI患者存在明显的病理生理异质性,缺血和充血通常共存,反应映流动-代谢偶联的异常。CBV增高可能与颅内压增高有关,但与CBF/CBV比值异常并存。这些结果强调在处理TBI患者时需要考虑脑血管病理生理的复杂性

脑缺血是创伤性脑损伤(TBI)后的重要病理生理机制,但其发生率和时空分布特征尚不清楚。近日研究人员综合表征了TBI后脑血管生理学的时空变化。

研究人员对TBI患者的脑血流量(CBF)、脑血容量(CBV)、脑氧代谢(Cmro2)、氧摄取指数进行考察。研究的主要终点为CBF/CMRO2和CBF/CBV,缺血性脑体积通过颈静脉饱和度与脑组织氧饱和度比值确定。

共招募68例TBI患者和20例对照者。TBI患者(女性13例[19%];平均年龄29岁)分别在早期(第1天[n=17])、中期(第2-5天[n=54])和晚期(第6-10天[n=19])进行90项研究,并与对照组(5名女性[25%];平均年龄,43岁)进行了比较。TBI患者的整体CBF和CMRO2结果低于各阶段对照组(CBF,26[22-30]mL/100 mL/min vs 38[29-49]mL/100 mL/min;CMRO2,62[55-71]μmol/100 mL/min vs 131[101-167]μmol/100 mL/min)。即使在没有颅内高压的情况下,缺血脑容量也会升高,并且在TBI后不到24小时达到高峰(36[10-82] ml),但许多患者随后出现了缺血性脑容量增加(在TBI后6-10天:24 [4-42] mL,所有时间段患者, 10 [5-39] mL  vs 对照组参与者 1 [0-3] mL)。缺血脑容量是颈静脉饱和度和脑组织血氧饱和度的不良指标。患者的CBF/CMRO2比值高于对照组(0.42[0.35-0.49]vs 0.3[0.28-0.33]),CBF/CBV比值低于对照组(7.1[6.4-7.9]vs 12.3[11.0-14.0]),提示血流代谢耦合异常和血管反应性异常。

研究认为缺血是常见的创伤性脑损伤早期症状,部分患者无颅内高血压,并且颈静脉或脑组织氧饱和度存在差异。TBI患者存在明显的病理生理异质性,缺血和充血通常共存,反应映流动-代谢偶联的异常。CBV增高可能与颅内压增高有关,但与CBF/CBV比值异常并存。这些结果强调在处理TBI患者时需要考虑脑血管病理生理的复杂性。

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    2020-10-26 yinhl1978
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    2020-08-05 amyloid
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    2019-11-18 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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