Principles of intracranial pressure monitoring and treatment
Principles of intracranial pressure monitoring and treatment
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DOI：
10.1016/b978-0-444-63600-3.00005-2
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发表时间：
2017-01-01
期刊：
影响因子：
--
通讯作者：
Steiner, L. A.
中科院分区：
文献类型：
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作者：
Czosnyka, M.;Pickard, J. D.;Steiner, L. A.
颅内压（ICP）由颅内血液、脑脊液和脑组织的体积控制。这些容积中任何一个的扩张都将触发其他腔室的代偿性变化，导致ICP最初的变化有限。由于颅骨坚硬，一旦代偿机制耗尽，颅内压上升非常迅速。颅内高压与脑损伤患者的不良预后相关。本章讨论了ICP升高的病理生理学，以及典型的波形，监测技术和临床管理。在任何给定的时间点，ICP的动态比绝对值更重要，但平均ICP超过20 - 25 mmHg通常被积极治疗。基于创伤性脑损伤患者数据的算法也适用于其他情况。然而，对潜在病理生理学的理解允许治疗适应于其他病理。通常，使用三阶段方法，从恢复全身生理学、镇静和镇痛开始。如果这些措施不充分，则考虑手术选择，如脑脊液引流或肿块病灶清除。在没有手术选择的情况下，开始第2阶段治疗，包括甘露醇或高渗盐水。如果这些措施不充分，第3阶段治疗包括低温，代谢抑制或颅骨切除术。
Intracranial pressure (ICP) is governed by volumes of intracranial blood, cerebrospinal fluid, and brain tissue. Expansion of any of these volumes will trigger compensatory changes in the other compartments, resulting in initially limited change in ICP. Due to the rigid skull, once compensatory mechanisms are exhausted, ICP rises very rapidly. Intracranial hypertension is associated with unfavorable outcome in brain-injured patients. This chapter discusses the pathophysiology of raised ICP, as well as typical waveforms, monitoring techniques, and clinical management. The dynamics of ICP are more important than the absolute value at any given time point, but mean ICP exceeding 20 - 25 mmHg is usually treated aggressively. Algorithms based on data from patients with traumatic brain injury are applied also in other conditions. However, an understanding of the underlying pathophysiology allows adaptation of therapies to other pathologies. Typically, a three-staged approach is used, starting with restoration of systemic physiology, sedation, and analgesia. If these measures are insufficient, surgical options, such as drainage of cerebrospinal fluid or evacuation of mass lesions, are considered. In the absence of surgical options, stage 2 treatments are initiated, consisting of either mannitol or hypertonic saline. If these measures are insufficient, stage 3 therapies include hypothermia, metabolic suppression, or craniectomy.