Temporal effects of barbiturate coma on intracranial pressure and compensatory reserve in children with traumatic brain injury.
Temporal effects of barbiturate coma on intracranial pressure and compensatory reserve in children with traumatic brain injury.
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巴比妥昏迷对外伤性脑损伤患儿颅内压及代偿储备的影响。
DOI：
10.1007/s00701-020-04677-z
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发表时间：
2021-03
影响因子：
2.4
通讯作者：
Enblad P
中科院分区：
文献类型：
--
作者：
Velle F;Lewén A;Howells T;Nilsson P;Enblad P
目的是研究巴比妥酸盐昏迷治疗（BCT）对创伤性脑损伤（TBI）和难治性颅内高压（RICH）儿童（< 17岁）颅内压（ICP）和颅内代偿储备（RAP指数）的影响。采用高分辨率监测数据研究BCT对ICP、平均动脉压（MAP）、脑灌注压（CPP）和RAP指数的影响。研究了四个半小时长的时间段：分别在推注前和推注后5、10和24小时，以及S-硫喷妥钠在< 100和< 30 μmol/L之间的第五个递减期。记录S-硫喷妥钠浓度和给药剂量。纳入了2007-2017年接受BCT治疗且具有高分辨率数据的17名儿童;中位年龄15岁（范围6-17），中位格拉斯哥昏迷评分7（范围3-8）。从创伤到开始BCT的中位时间为44.5 h（范围2.5-197.5），从开始到停止的中位时间为99.0 h（范围21.0-329.0）。BCT开始前半小时内的中位ICP为22（IQR 20-25），5小时后半小时内的中位ICP为16（IQR 11-20）（p = 0.011）。CPP的相应数字为65（IQR 62-71）和63（57-71）（p > 0.05）。RAP指数在BCT发作前半小时内为0.6（IQR 0.1-0.7），5小时后半小时内为0.3（IQR 0.1-0.7）（p = 0.331），整个BCT期间为0.3（IQR 0.2-0.4）（p = 0.004）。82%（14/17）的患者结局良好（恢复良好= 8例患者，中度残疾= 6例患者）。BCT显著降低ICP和RAP指数，保留CPP。在RICH的情况下应考虑BCT。
The aim was to study the effects of barbiturate coma treatment (BCT) on intracranial pressure (ICP) and intracranial compensatory reserve (RAP index) in children (< 17 years of age) with traumatic brain injury (TBI) and refractory intracranial hypertension (RICH). High-resolution monitoring data were used to study the effects of BCT on ICP, mean arterial pressure (MAP), cerebral perfusion pressure (CPP), and RAP index. Four half hour long periods were studied: before bolus injection and at 5, 10, and 24 hours thereafter, respectively, and a fifth tapering period with S-thiopental between < 100 and < 30 μmol/L. S-thiopental concentrations and administered doses were registered. Seventeen children treated with BCT 2007–2017 with high-resolution data were included; median age 15 (range 6–17) and median Glasgow coma score 7 (range 3–8). Median time from trauma to start of BCT was 44.5 h (range 2.5–197.5) and from start to stop 99.0 h (range 21.0–329.0). Median ICP was 22 (IQR 20–25) in the half hour period before onset of BCT and 16 (IQR 11–20) in the half hour period 5 h later (p = 0.011). The corresponding figures for CPP were 65 (IQR 62–71) and 63 (57–71) (p > 0.05). The RAP index was in the half hour period before onset of BCT 0.6 (IQR 0.1–0.7), in the half hour period 5 h later 0.3 (IQR 0.1–0.7) (p = 0.331), and in the whole BCT period 0.3 (IQR 0.2–0.4) (p = 0.004). Eighty-two percent (14/17) had favorable outcome (good recovery = 8 patients and moderate disability = 6 patients). BCT significantly reduced ICP and RAP index with preserved CPP. BCT should be considered in case of RICH.
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影响因子：
38.9
作者：
Howells, Tim;Lewen, Anders;Enblad, Per
通讯作者：
Enblad, Per
DOI：
10.1097/ta.0b013e3181de74c7
发表时间：
2010-08-01
影响因子：
--
作者：
Marshall, Gary T.;James, Robert F.;May, Addison K.
通讯作者：
May, Addison K.
影响因子：
4.8
作者：
Maas, AIR;Hukkelhoven, CWPM;Steyerberg, EW
通讯作者：
Steyerberg, EW
影响因子：
1.9
作者：
Figaji, Anthony A.;Zwane, Eugene;Peter, Jonathan C.
通讯作者：
Peter, Jonathan C.
DOI：
10.1159/000120397
发表时间：
1988-01-01
期刊：
PEDIATRIC NEUROSCIENCE
影响因子：
--
作者：
KASOFF, SS;LANSEN, TA;FILIPPO, JS
通讯作者：
FILIPPO, JS