Monitoring and interpretation of intracranial pressure
Monitoring and interpretation of intracranial pressure
复制标题
DOI：
10.1136/jnnp.2003.033126
复制
发表时间：
2004-06-01
影响因子：
11
通讯作者：
Pickard, JD
中科院分区：
文献类型：
--
作者：
Czosnyka, M;Pickard, JD
颅内压（ICP）来自脑血液和脑脊液（CSF）循环动力学，并且在许多中枢神经系统疾病的过程中会受到影响。ICP的监测需要有创传感器，尽管已经进行了一些尝试来非侵入性地测量ICP。由于其动态性质，通过腰椎穿刺使用液柱高度进行即时CSF压力测量可能会产生误导。平均超过30分钟应该是最低限度，在清醒的患者中进行一段时间的夜间监测提供了最佳标准。ICP的计算机辅助记录和在线波形分析是非常有帮助的。虽然没有“I类”证据，但颅内压监测在头部损伤、低级别蛛网膜下腔出血、中风、脑内血肿、脑膜炎、急性肝功能衰竭、脑积水、良性颅内高压、颅缝早闭等情况下是有用的（如果不是必需的）。可从颅内压及其波形获得的信息包括脑灌注压（CPP）、脑血流量和容量的调节、脑脊液吸收能力、脑代偿储备和血管源性事件内容。这些参数中的一些允许预测头部损伤后的生存预后和优化“CPP引导治疗”。在脑积水中，CSF动态测试有助于诊断和随后的分流功能监测。
Intracranial pressure (ICP) is derived from cerebral blood and cerebrospinal fluid (CSF) circulatory dynamics and can be affected in the course of many diseases of the central nervous system. Monitoring of ICP requires an invasive transducer, although some attempts have been made to measure it non-invasively. Because of its dynamic nature, instant CSF pressure measurement using the height of a fluid column via lumbar puncture may be misleading. An averaging over 30 minutes should be the minimum, with a period of overnight monitoring in conscious patients providing the optimal standard. Computer-aided recording with online waveform analysis of ICP is very helpful. Although there is no "Class I" evidence, ICP monitoring is useful, if not essential, in head injury, poor grade subarachnoid haemorrhage, stroke, intracerebral haematoma, meningitis, acute liver failure, hydrocephalus, benign intracranial hypertension, craniosynostosis etc. Information which can be derived from ICP and its waveforms includes cerebral perfusion pressure (CPP), regulation of cerebral blood flow and volume, CSF absorption capacity, brain compensatory reserve, and content of vasogenic events. Some of these parameters allow prediction of prognosis of survival following head injury and optimisation of "CPP-guided therapy". In hydrocephalus CSF dynamic tests aid diagnosis and subsequent monitoring of shunt function.