Intensive care for pediatric traumatic brain injury
Intensive care for pediatric traumatic brain injury
复制标题
小儿脑外伤的重症监护
DOI：
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发表时间：
2012
影响因子：
38.9
通讯作者：
N. Stocchetti
中科院分区：
文献类型：
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作者：
A. Sigurtà;C. Zanaboni;K. Canavesi;G. Citerio;Luigi Beretta;N. Stocchetti
目的本研究的目的是描述一组头部受伤的儿科患者，集中在目前的做法颅内压（ICP）监测和治疗，并验证临床和放射学参数和6个月的结果之间的关系，在一个多变量的统计model.MethodsA回顾性审查是一个前瞻性收集的数据库，考虑患者年龄小于19岁，承认三个神经系统，重症监护室（ICU）。患者分为4个年龄组：0-5岁（婴儿）、6-12岁（儿童）、13-16岁（青春期前）和17-18岁（青少年）。分析ICP和脑灌注压（CPP），计算平均数据和超过阈值超过5 min的值。结果进行了评估后6个月的创伤使用格拉斯哥Outcome Score.ResultsThere有199例，155名男性，包括。60%的人有颅外损伤。38%的患者瞳孔异常。81例颅内血肿需要急诊清除。对117例患者进行了ICP监测，其中87例ICP高于20 mmHg，年龄组间无差异。除6例患者外，所有患者均接受了预防ICP升高的治疗; 31例患者使用了巴比妥类药物、深度过度通气或手术减压。6个月时，死亡率为21%，72%的患者获得了良好的结局。在多变量模型的结果显着的预测因子是格拉斯哥昏迷量表（GCS）运动评分，瞳孔和ICP。早期手术治疗和重症监护可以在大多数情况下取得良好的结果。
PurposesThe aims of this study are to describe a cohort of head-injured pediatric patients, focusing on current practice for intracranial pressure (ICP) monitoring and treatment and to verify the relationship between clinical and radiological parameters and the six-month outcome in a multivariable statistical model.MethodsA retrospective review was done of a prospectively collected database considering patients younger than 19 years admitted to three neuro-intensive care units (ICU). Patients were divided into four age groups: 0–5 (infant), 6–12 (children), 13–16 (pre-adolescent) and 17–18 years (adolescent). The ICP and cerebral perfusion pressure (CPP) were analyzed calculating average data and values exceeding thresholds for more than 5 min. Outcome was assessed 6 months after trauma using the Glasgow Outcome Score.ResultsThere were 199 patients, 155 male, included. Sixty percent had extracranial injuries. Pupils were abnormal in 38 %. Emergency evacuation of intracranial hematomas was necessary in 81 cases. The ICP was monitored in 117 patients; in 87 cases ICP was higher than 20 mmHg, with no differences among age groups. All but six patients received therapy to prevent raised ICP; barbiturates, deep hyperventilation or surgical decompression were used in 31 cases. At 6 months, mortality was 21 % and favorable outcome was achieved by 72 %. Significant predictors of outcome in the multivariable model were the Glasgow Coma Scale (GCS) motor score, pupils and ICP.ConclusionsPediatric head injury is associated with a high incidence of intracranial hypertension. Early surgical treatment and intensive care may achieve favorable outcome in the majority of cases.
DOI：
10.1056/nejmsa0907130
发表时间：
2010-03-25
期刊：
The New England journal of medicine
影响因子：
--
作者：
Ross JS;Normand SL;Wang Y;Ko DT;Chen J;Drye EE;Keenan PS;Lichtman JH;Bueno H;Schreiner GC;Krumholz HM
通讯作者：
Krumholz HM