IMPACT OF ICP INSTABILITY AND HYPOTENSION ON OUTCOME IN PATIENTS WITH SEVERE HEAD TRAUMA
IMPACT OF ICP INSTABILITY AND HYPOTENSION ON OUTCOME IN PATIENTS WITH SEVERE HEAD TRAUMA
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DOI：
10.3171/sup.1991.75.1s.0s59
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发表时间：
1991-11-01
影响因子：
4.1
通讯作者：
JANE, JA
中科院分区：
文献类型：
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作者：
MARMAROU, A;ANDERSON, RL;JANE, JA
本研究描述了颅内压升高（ICP）、低血压和重型颅脑损伤预后之间的关系。这项研究是基于来自创伤性昏迷数据库的信息，其中来自相对大量患者的ICP记录可用于帮助描述影响结果的主要因素。从1030例患者的总数据库中，428例符合纳入本分析的最短监测持续时间标准。根据伤后6个月的格拉斯哥预后量表评分对预后进行分类。一系列描述患者病程的简明指标被考虑用于ICP、血压（BP）、中心灌注压和治疗强度水平。例如，ICP概要描述符阵列包括ICP读数大于x的比例，x = 0至80 mm Hg，增量为5 mm Hg。共审议了187个候选摘要描述符。逐步有序逻辑回归被用来选择候选人的总结描述符，最好地解释6个月outcome.As建立以前，年龄，入院运动评分，和异常的学生都是非常显着的解释结果的子集。除这些因素外，接下来选择每小时ICP读数大于20 mm Hg的比例，并且在解释结果方面也具有高度显著性（p < 0.0001）。除了ICP因素外，手术还选择20 mm Hg作为最能指示结果的临界点。在对这四个因素进行建模后，下一个选定的因素是每小时BP读数低于80 mm Hg的比例。同样，BP因子在解释结果方面具有高度显著性（p < 0.0001）。与ICP因素一样，客观选择BP临界点80 mm Hg作为最能指示结局的指标。总之，严重头部创伤导致的死亡率和发病率与ICP管理过程中测量的ICP升高和低血压密切相关。此外，这些ICP和BP因子提供了比类似定义的中心灌注压或治疗强度水平因子更好的结果指示。
This study describes the relationship between raised intracranial pressure (ICP), hypotension, and outcome from severe head injury. The study is based on information derived from the Traumatic Coma Data Bank where ICP records from a relatively large number of patients were available to help delineate the major factors influencing outcome. From the total data base of 1030 patients, 428 met minimum monitoring duration criteria for inclusion in the present analysis. Outcome was classified according to the Glasgow Outcome Scale score determined at 6 months postinjury. Arrays of comparably defined summary measures describing the patient's course were considered for ICP, blood pressure (BP), central perfusion pressure, and therapy intensity level. For instance, the array of ICP summary descriptors included the proportion of ICP readings greater than x, for x = 0 to 80 mm Hg by increments of 5 mm Hg. A total of 187 candidate summary descriptors were considered. A stepwise ordinal logistic regression was used to select the subset of candidate summary descriptors that best explained the 6-month outcome.As established previously, age, admission motor score, and abnormal pupils were each highly significant in explaining outcome. Beyond these factors, the proportion of hourly ICP readings greater than 20 mm Hg was next selected and was also highly significant in explaining outcome (p < 0.0001). In addition to the ICP factor, the cutoff point of 20 mm Hg was selected by the procedure as most indicative of outcome. With these four factors modeled, the next selected factor was the proportion of hourly BP readings less than 80 mm Hg. Again, the BP factor was highly significant in explaining outcome (p < 0.0001). As with the ICP factor, the BP cutoff point of 80 mm Hg was objectively selected as most indicative of outcome. In summary, the incidence of mortality and morbidity resulting from severe head trauma is strongly related to raised ICP and hypotension measured during the course of ICP management. Moreover, these ICP and BP factors provide a better indication of outcome than the similarly defined factors of central perfusion pressure or therapy intensity level.