AGGRESSIVE PHYSIOLOGIC MONITORING OF PEDIATRIC HEAD TRAUMA PATIENTS WITH ELEVATED INTRACRANIAL-PRESSURE
AGGRESSIVE PHYSIOLOGIC MONITORING OF PEDIATRIC HEAD TRAUMA PATIENTS WITH ELEVATED INTRACRANIAL-PRESSURE
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DOI：
10.1159/000120397
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发表时间：
1988-01-01
期刊：
影响因子：
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通讯作者：
FILIPPO, JS
中科院分区：
文献类型：
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作者：
KASOFF, SS;LANSEN, TA;FILIPPO, JS
严重头部创伤的儿科患者的管理往往需要积极的生理监测和治疗。随着颅内压（ICP）升高，死亡率也升高。然而，试图降低升高的ICP可能会导致生理和血液动力学问题。在这项对25例仅接受ICP监测、ICP测量加甘露醇或ICP测量加戊巴比妥（PB）诱导的昏迷/甘露醇治疗的患者进行的回顾性分析中，存活率高于预期，尤其是在最严重的损伤中。这些结果显然是由于重症监护和积极的监测。虽然已知巴比妥类药物可降低ICP，但不良反应（包括低血压、心血管抑制和心律失常）往往超过获益。血流动力学异常是不可预测的，使用Swan-Ganz导管进行监测对于管理PB诱导昏迷的患者很有用。儿科患者PB治疗的许多失败可能与未确诊的心输出量减少有关，导致脑血流量减少，即使ICP控制良好。
The management of pediatric patients with severe head trauma often requires aggressive physiologic monitoring and treatment. As intracranial pressure (ICP) increases, so does mortality. Yet attempts to decrease elevated ICP can cause physiologic and hemodynamic problems. In this retrospective analysis of 25 patients treated with ICP monitoring alone, ICP measurements plus mannitol, or ICP measurements plus pentobarbital (PB) induced coma/mannitol, survival rates were higher than predicted, particularly among the most severely injured. These results were apparently due to the intensive care and aggressive monitoring. Although barbiturates are known to decrease ICP, the adverse effects encountered, including hypotension, cardiovascular depression and arrhythmias, often outweigh the benefits. Hemodynamic abnormalities are unpredictable and monitoring with Swan-Ganz catheter is useful in managing patients with PB-induced comas. Many failures of PB therapy in pediatric patients may be related to undiagnosed decreases in cardiac output, resulting in decreased cerebral blood flow, even with well-controlled ICP.