INTRACRANIAL-PRESSURE WAVE-FORM INDEXES IN TRANSIENT AND REFRACTORY INTRACRANIAL HYPERTENSION
INTRACRANIAL-PRESSURE WAVE-FORM INDEXES IN TRANSIENT AND REFRACTORY INTRACRANIAL HYPERTENSION
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DOI：
10.1016/0165-0270(94)00106-q
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发表时间：
1995-03-01
影响因子：
3
通讯作者：
GROSSMAN, RG
中科院分区：
文献类型：
--
作者：
CONTANT, CF;ROBERTSON, CS;GROSSMAN, RG
本文分析了109例成人重型颅脑损伤患者颅内压（ICP）连续监测的结果，探讨了ICP波形指标的变化规律。检查了从ICP波的直接测量和从快速傅里叶变换（FFT）获得的指数。同时进行生理测量。定义了两种类型的颅内高压（ICH）进行比较。当ICP突然升高，随后恢复到25 mm Hg以下时，发生“一过性颅内高压”（n = 63）。进行性ICP升高并导致神经功能恶化和死亡被称为“难治性颅内高压”（n = 18）。在短暂性脑出血期间，心率、动脉压、潮气末二氧化碳和颈静脉血氧饱和度均升高，而在难治性脑出血期间，这些指标保持不变或降低。两种类型的ICHtn的ICP波的脉冲幅度增加。波形指数的其他变化与脉冲幅度的变化一致。HFC对两种类型的变化的反应不同，在瞬态变化期间增加，在不应期变化期间减少。两组中发生ICH时生理测量值变化的差异表明，在难治性ICH中，脑血流量是针对不断升高的ICP而维持的，而在短暂性ICH中，高血压是由脑血流量增加引起的。波形指数不能区分这两种类型的变化。
Analysis of data obtained by continuous computerized monitoring of intracranial pressure (ICP) in 109 adult patients with severe head trauma was performed to examine the patterns of change in indices of the ICP waveform. Indices derived from direct measurement of the ICP wave and obtained from a Fast Fourier Transform (FFT) were examined. Concurrent physiologic measurements were made. Two types of intracranial hypertension (ICH) were defined for comparison. 'Transient intracranial hypertension' occurred when an abrupt rise in ICP was followed by a return to below 25 mm Hg (n = 63). Increases in ICP that were progressive and led to neurologic deterioration and death were termed 'refractory intracranial hypertension' (n = 18). During transient ICH heart rate, arterial pressure, end-tidal carbon dioxide and jugular venous oxygen saturation all increased, while these measures either were unchanged or decreased during refractory ICH. The pulse amplitude of the ICP wave increased in both types of ICHtn. Other changes in the waveform indices were consistent with this change in pulse amplitude. HFC responded differently to the two types of changes, with an increase during the transient changes and a decrease during the refractory changes. The differences in changes in physiologic measurements as ICH occurred in the 2 groups suggest that in refractory ICH cerebral blood flow is maintained against the mounting ICP, while in transient ICH the hypertension is caused by an increase in cerebral blood flow. The waveform indices do not discriminate between the two types of changes.