Secondary insults in severe head injury -: Do multiply injured patients do worse?
Secondary insults in severe head injury -: Do multiply injured patients do worse?
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DOI：
10.1097/00003246-200106000-00004
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发表时间：
2001-06-01
影响因子：
8.8
通讯作者：
Unterberg, AW
中科院分区：
文献类型：
--
作者：
Sarrafzadeh, AS;Peltonen, EE;Unterberg, AW
目的：研究闭合性重型颅脑损伤（格拉斯哥昏迷量表评分小于或等于8分）患者二次损伤的发生以及颅外损伤对脑氧合和预后的影响。设计：为期两年的前瞻性临床研究。设置：三级创伤中心的两个重症监护室。患者：我们研究了119例患者。80例重度颅脑损伤患者分为两类：“孤立性”重度颅脑损伤患者（n = 36，损伤严重度评分< 30）和伴有颅外损伤的重度颅脑损伤患者（n = 44，损伤严重度评分> 29）。39例颅外损伤且无头部损伤的患者作为对照组。患者入住重症监护室后，我们开始对重型颅脑损伤患者进行连续多模式脑监测，包括颅内压、平均动脉压、脑灌注压、潮气末CO-2、脑组织Po-2（Licox）、颈静脉球血氧饱和度，对照组平均动脉血压。管理目标包括颅内压< 20 mm Hg、脑灌注压> 60 mm Hg、Paco（2）> 30 mm Hg、控制脑氧合作用以及对非危及生命的颅外病变延迟手术。测量和主要结果：分析数据的临界阈值。二次损伤的发生率（颅内压> 20 mm Hg，平均动脉压< 70 mm Hg，脑灌注压< 60 mm Hg，潮气末CO-2
Objectives: To study the occurrence of secondary insults and the influence of extracranial injuries on cerebral oxygenation and outcome in patients with closed severe head injury (Glasgow Coma Scale score less than or equal to8).Design: Two-year prospective, clinical study.Setting: Two intensive care units in a level III trauma center.Patients: We studied 119 patients. Eighty patients had severe head injury and were divided into two categories: "isolated" severe head injury patients (n = 36, Injury Severity Score < 30), and severe head injury patients with associated extracranial injuries (n = 44, injury Severity Score > 29). Thirty-nine patients with extracranial injuries and no head injury served as the control group.Interventions: After patients were admitted to the intensive care unit, we began continuous multimodal cerebral monitoring of intracranial pressure, mean arterial blood pressure, cerebral perfusion pressure, end-tidal Co-2, brain tissue Po-2 (Licox), jugular bulb oxyhemoglobin saturation in severe head injury patients, and mean arterial blood pressure in the control group. Targets of management included intracranial pressure < 20 mm Hg, cerebral perfusion pressure > 60 mm Hg, Paco(2) > 30 mm Hg, control of cerebral oxygenation, and delayed surgery for non-life-threatening extracranial lesions.Measurements and Main Results: Data were analyzed for critical thresholds. The occurrence of secondary insults (intracranial pressure > 20 mm Hg, mean arterial blood pressure < 70 mm Hg, cerebral perfusion pressure < 60 mm Hg, end-tidal Co-2