Control of intracranial pressure in patients with severe head injury.
Control of intracranial pressure in patients with severe head injury.
复制标题
严重颅脑损伤患者颅内压的控制。
作者：
J. Miller;Dearden Nm;I. Piper;Chan Kh
颅内压升高（ICP）在50-75%的严重颅脑损伤患者中发生。仅测量ICP是不够的。动脉压也必须监测：重要的生理变量是脑灌注压。对ICP记录的详细分析可提供有关ICP的性质和原因的宝贵信息，并对适当的治疗产生影响。其他重要的测量包括脑电活动，动脉和颈静脉氧饱和度，以及经颅多普勒超声测量的颅内主要动脉的血流速度。这些评估不仅增加了颅内高压（血管性vs.非血管性）病因的信息，而且有助于调节治疗，为降低ICP的治疗实际上是产生全局性脑缺血提供早期预警。在颅内压升高的处理中，首先要处理所有可纠正的因素，然后根据颅内压升高的原因分别是血管性还是非血管性，选择催眠药物还是渗透治疗。
Raised intracranial pressure (ICP) occurs at some time in 50-75% of severely head injured patients. Measurement of ICP alone is not sufficient. Arterial pressure must also be monitored: the important physiological variable is cerebral perfusion pressure. Detailed analysis of the ICP recording yields valuable information on the nature and cause of ICP, with implications for appropriate therapy. Additional measurements of importance include brain electrical activity, arterial and jugular venous oxygen saturation, and blood flow velocity in major intracranial arteries measured by transcranial Doppler sonography. These assessments not only add information about the cause of intracranial hypertension (vascular vs. nonvascular) but also help to regulate therapy, providing early warning that a treatment for reducing the ICP is actually producing global brain ischemia. In the management of raised ICP, all correctable factors must first of all be dealt with, then a choice made between hypnotic drugs and osmotic therapy according to whether the cause of raised ICP is, respectively, vascular or nonvascular.