Hemodynamic characterization of intracranial pressure plateau waves in head-injured patients
Hemodynamic characterization of intracranial pressure plateau waves in head-injured patients
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DOI：
10.3171/jns.1999.91.1.0011
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发表时间：
1999-07-01
影响因子：
4.1
通讯作者：
Pickard, JD
中科院分区：
文献类型：
--
作者：
Czosnyka, M;Smielewski, P;Pickard, JD
Object.颅内压（ICP）的平台波经常记录在重症监护监护严重的头部受伤的病人。由于脑灌注压（CPP）急剧下降，它们传统上被解释为有意义的二次脑损伤。本研究的目的是探讨血流动力学的特点和临床后果的平台波。对160例颅脑损伤患者进行颅内压连续监测。这些患者中几乎20%表现出平台波。对96例患者进行了动脉压、ICP和经颅多普勒（TCD）血流速度的研究，每天20分钟至3小时。记录并分析了8例患者的16次平台波，ICP显著升高后CPP显著下降（下降45%）。相比之下，现在的速度只下降了20%。在平台期前后，自动调节被证明是完整的，但在波期间被干扰（p < 0.05）。压力-容量代偿储备总是在波前耗尽。脑血管阻力下降60%（p < 0.05），TCD搏动性增加（p < 0.05）。高原波并没有增加损伤后不良结局的可能性。作者已证实平台波是与脑血管舒张相关的血流动力学现象。在脑自动调节功能保留但压力-容量代偿储备减少的患者中观察到。
Object. Plateau waves of intracranial pressure (ICP) are often recorded during intensive care monitoring of severely head injured patients. They are traditionally interpreted as meaningful secondary brain insults because of the dramatic decrease in cerebral perfusion pressure (CPP). The aim of this study was to investigate both the hemodynamic profile and the clinical consequences of plateau waves.Methods. One hundred sixty head-injured patients were studied using continuous monitoring of ICP. almost 20% of these patients exhibited plateau waves. In 96 patients arterial pressure, ICP, and transcranial Doppler (TCD) blood flow velocity were studied daily for 20 minutes to 3 hours. Sixteen episodes of plateau waves in eight patients were recorded and analyzed.The dramatic increase in ICP was followed by a profound fall in CPP (by 45%). In contrast, now velocity fell by only 20%. Autoregulation was documented to be intact both before and after plateau but was disturbed during the wave (p < 0.05). Pressure-volume compensatory reserve was always depleted before the wave. Cerebrovascular resistance decreased during the wave by 60% (p < 0.05) and TCD pulsatility increased (p < 0.05). Plateau waves did not increase the probability of an unfavorable outcome following injury.Conclusions. The authors have confirmed that the plateau waves are a hemodynamic phenomenon associated with cerebrovascular vasodilation. They are observed in patients with preserved cerebral autoregulation but reduced pressure-volume compensatory reserve.