Effect of decompressive craniectomy on intracranial pressure and cerebrospinal compensation following traumatic brain injury
Effect of decompressive craniectomy on intracranial pressure and cerebrospinal compensation following traumatic brain injury
复制标题
DOI：
10.3171/jns/2008/108/01/0066
复制
发表时间：
2008-01-01
影响因子：
4.1
通讯作者：
Hutchinson, Peter
中科院分区：
文献类型：
--
作者：
Timofeev, Ivan;Czosnyka, Marek;Hutchinson, Peter
object.去骨瓣减压术是控制创伤性脑损伤患者颅内压（ICP）的先进治疗选择。本研究的目的是评估去骨瓣减压术对颅内压和脑脊髓代偿的影响，无论是在第一个24小时内和以后的开颅手术。本研究回顾性分析了27例因进行性脑水肿而接受去骨瓣减压术的中重度颅脑损伤患者的生理参数。其中，17名患者。进行ICP的前瞻性数字记录，估计ICP波形衍生指数。采用压力-容积代偿储备（RAP）指数和脑血管压力反应性指数（PRx）评估这些参数。分析去骨瓣减压术前和术后72 h内的各项参数。去骨瓣减压术导致中位（四分位距）ICP值持续降低（术前21.2 mm Hg [18.7; 24.2 mm Hg]，术后15.7 mm Hg [12.3; 19.2 mm Hg]; p = 0.01）。在RAP中观察到类似的改善。与术前相比，去骨瓣减压术后需要显著降低平均动脉压（MAP）以维持最佳脑灌注压（CPP）水平（分别为99.5 mm Hg [96.2; 102.9 mm Hg]和94.2 mm Hg [87.9; 98.9 mm Hg]; p = 0.017）。去骨瓣减压术后，所有患者的PRx均为正值，提示压力反应性获得性紊乱。在这项研究中，去骨瓣减压术导致颅内压持续降低和脑顺应性改善。去骨瓣减压术后MAP水平降低可能表明治疗强度降低。脑血管压力反应性紊乱需要进一步的研究来评估其意义和对预后的影响。
Object. Decompressive craniectomy is an advanced treatment option for intracranial pressure (ICP) control in patients with traumatic brain injury. The purpose of this study was to evaluate the effect of decompressive craniectomy on ICP and cerebrospinal compensation both within and beyond the first 24 hours of craniectomy.Methods. This study was a retrospective analysis of the physiological parameters from 27 moderately to severely head-injured patients who underwent decompressive craniectomy for progressive brain edema. Of these, 17 patients had. undergone prospective digital recording of ICP with estimation of ICP waveform-derived indices. The pressure-volume compensatory reserve (RAP) index and the cerebrovascular pressure reactivity index (PRx) were used to assess those parameters. The values of parameters prior to and during the 72 hours after decompressive craniectomy were included in the analysis.Results. Decompressive craniectomy led to a sustained reduction in median (interquartile range) ICP values (21.2 mm Hg [18.7; 24.2 mm Hg] preoperatively compared with 15.7 mm Hg [12.3; 19.2 mm Hg] postoperatively; p = 0.01). A similar improvement was observed in RAP. A significantly lower mean arterial pressure (MAP) was needed after decompressive craniectomy to maintain optimum cerebral perfusion pressure (CPP) levels, compared with the preoperative period (99.5 mm Hg [96.2; 102.9 mm Hg] compared with 94.2 mm Hg [87.9; 98.9 mm Hg], respectively; p = 0.017). Following decompressive craniectomy, the PRx had positive values in all patients, suggesting acquired derangement in pressure reactivity.Conclusions. In this study, decompressive craniectomy led to a sustained reduction in ICP and improvement in cerebral compliance. Lower MAP levels after decompressive craniectomy are likely to indicate a reduced intensity of treatment. Derangement in cerebrovascular pressure reactivity requires further studies to evaluate its significance and influence on outcome.