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首页> 外文期刊>Neurosurgery >Cerebral blood flow in traumatic contusions is predominantly reduced after an induced acute elevation of cerebral perfusion pressure.
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Cerebral blood flow in traumatic contusions is predominantly reduced after an induced acute elevation of cerebral perfusion pressure.

机译：诱导性脑灌注压急性升高后，主要是挫伤性挫伤的脑血流减少。

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OBJECTIVE: To evaluate the response to an acute elevation of cerebral perfusion pressure (CPP) of the regional cerebral blood flow (rCBF) measured in the edematous area of traumatic contusions. METHODS: rCBF was measured in the intracontusional low-density area, in the pericontusional healthy-appearing brain tissue surrounding the contusion, in a healthy-appearing area in the contralateral hemisphere, in 16 head-injured patients with 16 traumatic contusions larger than 2 cm at baseline, and after 20 minutes of norepinephrine-induced 20-mmHg elevation of CPP levels. RESULTS: After an induced acute elevation of CPP from baseline values of 65.8 ml/100 g/min (standard deviation, 8.6) to final values of 88.7 ml/100 g/min (standard deviation, 8.9; P < or = 0.0001), we found that rCBF mean levels decreased in the intracontusional low-density area (P = 0.0278), and change in rCBF was inversely associated to the baseline values. After grouping contusions according to the rCBF response to induced acute CPP elevation, rCBF mean values recorded at baseline were significantly lower in lesions with "rCBF improvement" than in those with "rCBF reduction" in the intracontusional low-density area (P = 0.0435). CONCLUSION: Our findings suggest that CPP elevation induced by norepinephrine is effective in improving contusional rCBF only in selected cases, which are represented by a subset of contusions with critical perfusion, which can be identified by rCBF measurements. Conversely, in contusions with rCBF higher than critical low values, the CPP elevation could probably induce a temporary breakdown of the blood brain barrier, and the norepinephrine leads to a vasoconstriction with a worsening of regional perfusion.
机译：目的：评估对创伤性挫伤水肿区域中局部脑血流（rCBF）的急性脑灌注压（CPP）的反应。方法：在挫伤内低密度区域，在挫伤周围的挫伤周围出现健康的脑组织，对侧半球的健康出现区域，16例头部受伤的，大于2 cm的创伤性挫伤患者中测量rCBF在基线时，以及去甲肾上腺素引起的CPP水平升高20 mmHg 20分钟后。结果：诱导的CPP急性升高，从基线值65.8 ml / 100 g / min（标准偏差8.6）到最终值88.7 ml / 100 g / min（标准偏差8.9; P <或= 0.0001），我们发现，挫伤内低密度区域的rCBF平均水平下降（P = 0.0278），并且rCBF的变化与基线值呈负相关。根据对诱导的急性CPP升高的rCBF响应对挫伤进行分组后，在挫伤性低密度区域，“ rCBF改善”病变的基线基线记录的rCBF平均值明显低于“ rCBF减少”病变的基线（P = 0.0435） 。结论：我们的研究结果表明，去甲肾上腺素引起的CPP升高仅在某些情况下可有效改善挫伤性rCBF，其表现为具有关键性灌注的挫伤亚群，可通过rCBF测量确定。相反，在rCBF高于临界低值的挫伤中，CPP升高可能会引起血脑屏障的暂时性破坏，而去甲肾上腺素会导致血管收缩，导致局部灌注恶化。

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