Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after head injury
Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after head injury
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DOI：
10.1385/ncc:4:1:008
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发表时间：
2006-02-01
影响因子：
3.5
通讯作者：
Pickard, John D.
中科院分区：
文献类型：
--
作者：
Balestreri, Marcella;Czosnyka, Marek;Pickard, John D.
目的：探讨颅内压（ICP）、脑灌注压（CPP）与颅脑损伤预后的关系。材料和方法：回顾性分析来自英国剑桥大学神经科学重症监护室和神经重症监护室的429例需要强化治疗的头部损伤患者的前瞻性记录数据。连续记录ICP、CPP、动脉血压（ABP）。将压力平均值与损伤后6个月评估的结果进行比较（使用格拉斯哥结果量表）。结果：平均颅内压大于20mmhg的患者死亡率更高（低于17%，高于47%，p < 0.0001）。CPP低于55毫米汞柱时，死亡率显著增加（低于55毫米汞柱时为81%，高于55毫米汞柱时为23%，p < 0.0001）。对于CPP值大于95 mmHg的患者，良好的预后较少（低于50%，高于28%；p < 0.033）。严重致残率随CPP的增加而增加（r=0.87; p=0.02），提示较高的CPP无助于获得良好的结果。死亡患者的ICP高于存活患者（27 +/- 19 mmHg vs 16 +/- 6 mmHg, p < 0.10-7）， CPP较低（68 +/- 21 mmHg vs 76 +/- 10 mmHg, p < 0.0002）。在良好/中度和重度残疾结局组中，平均ICP和CPP没有差异。结论：高颅内压与致死性预后密切相关。过度的CPP似乎降低了头部创伤后获得良好结果的可能性。
Objective: To investigate the relationships between intracranial pressure (ICP), cerebral perfusion pressure (CPP), and outcome after traumatic brain injury.Material and Methods: A retrospective analysis of prospectively recorded data from 429 patients after head injury requiring intensive treatment on the Neuroscience Intensive Annex and the Neuro Critical Care Unit, Cambridge, UK. ICP, CPP, and arterial blood pressure (ABP) were continuously recorded. Mean values of pressures were compared to outcome assessed at 6 months after injury (using the Glasgow Outcome Scale).Results: The mortality rate was greater in those having mean ICP greater than 20 mmHg (17% below versus 47% above; p < 0.0001). The mortality rate was dramatically increased for CPP below 55 mmHg (81% below versus 23% above; p < 0.0001). For values of CPP greater than 95 mmHg, favorable outcome was less frequent (50% below versus 28% above; p < 0.033). The rate of severe disability showed the tendency to increase with CPP (r=0.87; p=0.02), suggesting that a higher CPP does not help in achieving favorable outcomes.ICP was greater in those who died in comparison to those who survived ( 27 +/- 19 mmHg versus 16 +/- 6 mmHg; p < 0.10-7), and CPP was lower (68 +/- 21 versus 76 +/- 10 mmHg; p < 0.0002). There was no difference between mean ICP and CPP in good/moderate and severe disability outcome groups.Conclusion: High ICP is strongly associated with fatal outcome. Excessive CPP seems to reduce the probability of achieving a favorable outcome following head trauma.