浙江大学学报(医学版)
浙江大學學報(醫學版)
절강대학학보(의학판)
Journal of Zhejiang University (Medical Sciences)
2015年
4期
451-457
,共7页
郑跃英%潘彩飞%祝胜美
鄭躍英%潘綵飛%祝勝美
정약영%반채비%축성미
脑%血流速度%超声检查,多普勒,经颅%颅内压%谱学,近红外线%手术期间%综述
腦%血流速度%超聲檢查,多普勒,經顱%顱內壓%譜學,近紅外線%手術期間%綜述
뇌%혈류속도%초성검사,다보륵,경로%로내압%보학,근홍외선%수술기간%종술
Brain%Blood flow velocity%Ultrasonography,Doppler,transcranial%Intracranial pressure%Spectroscopy,near-infrared%Intraoperative period%Review
脑血流自动调节是维持脑血流量稳定的生理性保护机制。一旦失调脑血流量将随血压升降而被动涨落,机体可能面临脑充血或脑缺血的风险。采用相关分析法将反映脑血流量的间接参数与自发性波动的血压进行实时相关分析,可以实现脑血流自动调节的实时监测。脑血流自动调节的完好与否与心脏手术、肝移植手术及需要特殊体位的手术患者的中枢神经系统并发症密切相关。脑血流自动调节的持续监测可以为脑血流自动调节的血压上限或下限提供信息,有望为临床医生对围手术期患者进行合理的血压调控和脑功能保护提供可靠依据。
腦血流自動調節是維持腦血流量穩定的生理性保護機製。一旦失調腦血流量將隨血壓升降而被動漲落,機體可能麵臨腦充血或腦缺血的風險。採用相關分析法將反映腦血流量的間接參數與自髮性波動的血壓進行實時相關分析,可以實現腦血流自動調節的實時鑑測。腦血流自動調節的完好與否與心髒手術、肝移植手術及需要特殊體位的手術患者的中樞神經繫統併髮癥密切相關。腦血流自動調節的持續鑑測可以為腦血流自動調節的血壓上限或下限提供信息,有望為臨床醫生對圍手術期患者進行閤理的血壓調控和腦功能保護提供可靠依據。
뇌혈류자동조절시유지뇌혈류량은정적생이성보호궤제。일단실조뇌혈류량장수혈압승강이피동창락,궤체가능면림뇌충혈혹뇌결혈적풍험。채용상관분석법장반영뇌혈류량적간접삼수여자발성파동적혈압진행실시상관분석,가이실현뇌혈류자동조절적실시감측。뇌혈류자동조절적완호여부여심장수술、간이식수술급수요특수체위적수술환자적중추신경계통병발증밀절상관。뇌혈류자동조절적지속감측가이위뇌혈류자동조절적혈압상한혹하한제공신식,유망위림상의생대위수술기환자진행합리적혈압조공화뇌공능보호제공가고의거。
Cerebral blood flow autoregulation is physiologically protective mechanism to maintain the stability of cerebral blood flow.Once autoregulation is impaired, the cerebral blood flow fluctuates with blood pressure, leading to the risk of brain ischemia or cerebral hyperemia.Multiple research results indicate that cerebral blood flow can be monitored indirectly and continuously with transcranial Doppler, near infrared spectroscopy or ICP.The correlation coefficient calculated by the surrogate for cerebral blood flow and blood pressure is used to judge cerebral blood flow autoregulation.When the correlation coefficient is close to 1, cerebral blood flow will be passively fluctuated by blood pressure, indicating autoregulation is impaired.When the coefficient is less than 0, cerebral blood flow will not be changed with blood pressure, indicating autoregulaiton is intact.The status of autoregualtion is closely associated with mortality or poor neurological outcomes in patients with cardiac surgery underwent cardiopulmonary bypass, liver transplantation patients or patients with deep trendelenburg position for long time or beach chair position.Continuous monitoring of cerebral blood flow autoregulation can identify the lower or the upper limit of autoregulation, and provide information to individualize the perioperative management of blood pressure.