Effect of hyperventilation, mannitol, and ventriculostomy drainage on cerebral blood flow after head injury.
Effect of hyperventilation, mannitol, and ventriculostomy drainage on cerebral blood flow after head injury.
复制标题
过度换气、甘露醇和脑室造口引流对头部损伤后脑血流的影响。
DOI：
10.1097/00005373-199512000-00014
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发表时间：
1995
期刊：
影响因子：
--
通讯作者：
Kuehler,DH
中科院分区：
文献类型：
--
作者：
Fortune,JB;Feustel,PJ;Graca,L;Hasselbarth,J;Kuehler,DH
Therapies to lower intracranial pressure (ICP) after traumatic brain injury (TBI) include hyperventilation (HV), intravenous mannitol (IM), and cerebrospinal fluid drainage from a ventriculostomy (DV). To determine the effects of these therapies on cerebral blood flow (CBF), fiberoptic oximetry was used to measure jugular venous O 2 saturation (S j v O 2) as an index of the CBF to cerebral metabolic rate for O 2 (CMRO 2) ratio after IM (25 g IV for more than 5 min), DV (3 min), or HV (increase respiratory rate by 4) therapy for elevated ICP. Assuming CMRO sub 2 is constant, changes in S j v O 2 reflect changes in CBF. Continuous measurements of S j v O 2, ICP, blood pressure, arterial O 2 saturation, and end-tidal CO 2 were obtained in 22 patients with a Glasgow Coma Scale score of 5.3+/-0.4 (mean+/-SD) in the first 5 days after TBI. Therapy was initiated a total of 196 times when ICP was> 15 mm Hg for> 5 minutes, and measurements made at 20 minutes after treatment were compared with those made just before. After DV, ICP fell in 90% of the observations by 8.6+/-0.7 mm Hg (mean+/-SEM, n= 119); after IM, ICP fell in 90% of the observations by 7.4+/-0.7 mm Hg (n= 43); and after HV, ICP fell in 88% of the observations by 6.3+/-1.2 mm Hg (n= 14). In patients where ICP fell, S j v O 2 increased by 2.49+/-0.7% saturation (from 68.0+/-1.3%) with IM, but only by 0.39+/-0.4% saturation (from 67.2+/-0.9%) with DV. When HV resulted in a decrease in ICP, S j v O 2 decreased by 7.7+/-1.0% saturation (from 63.4+/-2.5%). The magnitude of the effect was assessed by considering the change in S j v O 2 resulting from a measured change in ICP (S j v O 2/ICP). For each decrease in ICP of 1 mm Hg, S j v O 2 increased 0.53+ 0.14% saturation with IM, 0.10+/-0.10 with DV, and decreased by 1.95+/-0.53 with HV. In this study DV, IM, and HV effectively reduced elevated ICP after cerebral injury. For a given change in ICP, however, IM increased the CBF to CMRO sub 2 ratio nearly five times as much as DV, whereas HV decreased this ratio in all cases. These data suggest that mannitol improves CBF while reducing ICP; HV, although effective at reducing ICP, results in marked lowering of CBF and should be used cautiously.
