无创颅内压监测对治疗创伤性急性弥漫性脑肿胀的临床价值

[目的]探讨无创颅内压(ICP)监测对治疗创伤性急性弥漫性脑肿胀(PADBS)的临床指导作用.[方法]回顾性分析2009年1月至2014年12月长沙市解放军第163医院神经外科收治的69例PADBS患者的临床资料,均于伤后2~24 h内在ICU病房予以无创颅内压监护仪(MICP-1A闪光视觉诱发电位无创颅内压检测分析仪)进行监护.根据患者入院时无创ICP值分为轻、中、重度颅内高压三种类型, 根据患者临床症状、头颅CT及无创颅内压监测值予以对症治疗,比较不同类型患者的格拉斯哥预后评分(GOS)评估预后情况.[结果]本组病例预后良好率为43.5% (30/69),预后不良率56.5% (39/69),病死率31.8%(22/69).轻度颅内高压患者预后良好率为90.1% (10/11), 中度颅内高压预后良好率为65.22% (15/23),重度颅内高压预后良好率为14.29% (5/35), 轻度颅内高压患者预后良好率显著高于中、重度颅内高压预后良好者,差异具有统计学意义(均P<0.05).重度颅内高压患者死亡所占比例显著高于轻、中度颅内高压患者,差异具有统计学意义(均P<0.05).[结论]根据持续无创ICP监测结果给予对症治疗,对创伤性急性大脑弥漫性脑肿胀的治疗有重要的指导作用.     

颅内压连续监护仪在高血压脑出血患者中的应用及护理

持续颅内压监测是采用传感器和监护仪动态测定颅内压的一种方法,目前已被认为是直接诊断颅内高压最迅速、客观和准确的方法,也是观察患者病情变化、判断手术时机、指导临床用药和评估预后的必备手段之一〔1〕。     

颅内压增高时经颅多普勒超声监测的新进展

颅内压(intracranialpressure,ICP)增高是神经科临床工作中经常遇到的一个重要问题。颅内压持续超过200mmH2O(15mmHg或200kPa)即为颅内压增高或颅内高压(intracranialhypertension,ICH)。许多重症神经系统疾病都伴有不同程度的颅内压增高,其可降低脑灌注,引起不良后果,因而加强对颅内压增高的监测具有重要的临床意义。经颅多普勒超声(transcranialDopplerultrasonography,TCD)是一无创性监测工具,具有简便易行、安全无创和床旁检测等诸多优点。根据其血流速度及其频谱的变化,可对颅内压增高患者脑血流动力学进行动态监测与评估。脑血…     

持续颅内压监测的护理与进展

颅内压增高（increased intracranial pressur）是颅内疾病及颅内继发病变的反应,也是神经外科疾病引起死亡的重要原因。颅内压（intracranial pressure,ICP）监测是采用传感器和监护仪动态测定颅内压的一种方法,目前已被认为是直接诊断颅内高压最迅速、客观和准确的方法,也是观察脑疾病患者病情变化、判断手术时机、指导临床用药和评估预后的必备手段之一。     

有创颅内压监测在创伤性急性弥漫性脑肿胀临床救治中的作用

目的 探讨有创颅内压监测在创伤性急性弥漫性脑肿胀患者临床救治中的作用.方法 对27例首次CT影像显示弥漫性脑肿胀、手术指征不明确的中、重型颅脑创伤患者于伤后6 h内行有创颅内压持续监测,观察颅内压的变化.结果 保守治疗成功17例,因颅内高压中转手术10例.伤后随访6～17个月,GOS评分:恢复良好18例 (66.7%),中度残疾6例(22.20%),植物生存3例(11.1%),无死亡病例.无因行颅内压监测探头置入而并发颅内感染及颅内出血的病例.结论 有创颅内压监测可及时了解颅内压变化,对创伤性弥漫性脑肿胀患者的临床救治有重要的指导作用,并且较安全.     

闪光视觉诱发电位对颅内压变化的评估作用

目的:研究在不同颅内压水平时闪光视觉诱发电位(flashvisualevolcedpotentials,fVEP)和有创颅内压监测的相关性和一致性,探讨fVEP无创监测颅内压的可行性。方法:138例颅内高压患者用fVEP与腰椎穿刺测压或脑硬膜外测压法同时检测,有创监测均在fVEP完成后进行。结果:fVEP的Ⅲ波潜伏期与颅内压增高呈线性相关(r=0.97),配对t检验示两者差异无显著性意义(P>0.05),平均相对误差δ=13.22%,但波幅改变无规律。结论:fVEP可以无创监测颅内压。     

视神经鞘超声检查评估颅内压增高的研究进展

颅内压增高是临床常见的危重急症之一,严重影响患者脑功能甚至危及患者生命。因此迅速、准确地评估颅内压以便及时采取临床干预和对后续治疗效果至关重要。基于视神经鞘直径能随颅内压力改变的原理,超声测量视神经鞘直径能够无创、快速地评估颅内压增高。本文就国内外视神经鞘超声评估颅内压增高的研究进展进行综述。     

颅内压监测的应用价值及发展趋势

颅内压 (intracranialpressure ,ICP)监测是采用传感器和监护仪动态测定颅内压的一种方法。自从 195 1年Guillaume和196 0年Lundberg先后将ICP监测技术应用于神经外科临床以来 ,现已被广大临床工作者所接受、完善与发展。目前已被认为是直接诊断颅内高压最迅速、客观和准确的方法[1] ,也是观察颅脑疾病患者病情变化、判断手术时机、指导临床用药和评估预后的必备手段之一[2 ] 。国外现已广泛应用于神经外科、神经内科、儿科及其他内科等颅内高压性疾病的监测。随着现代科技的不断进步 ,ICP监测装置趋向无创化、多功能化方向发展。本文…     

颅内压监护的临床应用价值

自1960年Lundberg首先将颅内压监护用于神经外科临床以来,颅内压监护已逐渐在世界范围内发展成为重型神经外科患者术前或术后观察的重要方法之一。我科1994年12月至1995年11月对26例患者进行了27次的颅内压监护,体会到它对于了解颅内压的变化、诊断颅内高压、指导治疗、帮助预后评估有重要价值。 1 材料与方法 1.1 仪器:采用无锡海鹰传感器公司生产的海鹰牌SJN——2081型颅内压监护仪及其光纤探头,     

急性局灶性颅内压升高动物模型的建立及颅内压升高对经颅多普勒频谱影响的实验研究

目的 建立急性局灶性颅内高压动物模型,探讨兔颅内高压状态下经颅多普勒(TCD)频谱动态变化规律,为临床应用TCD无创监测颅内压(ICP)、脑灌注压(CPP)提供实验依据.方法 用硬膜外球囊注水法制作急性局灶性颅内高压动物模型,持续监测兔ICP、CPP及基底动脉TCD.结果 随着颅内压升高,依次出现5种典型的TCD频谱:高阻力血流频谱、收缩峰、舒张期逆向血流、极小的收缩峰、无血流.结论 根据TCD频谱变化能够定性判断颅内压和脑灌注压.本动物模型简便、严密,具有推广价值.     

The influence of urapidil,a new antihypertensive agent,on cerebral perfusion pressure in dogs with and without intracranial hypertension

The influence of urapidil, an arylpiperazinederivate, on intracranial pressure (ICP), mean arterial pressure (MAP) and cerebral perfusion pressure (CPP) was investigated in dogs with (group II) and without (group I) intracranial hypertension. After i.v. administration of urapidil, intracranial pressure remained unchanged and cerebral perfusion pressure decreased to the same extent as mean arterial pressure (20%). As in neurosurgical patients, autoregulation of cerebral blood flow is often lost; a sudden increase in blood pressure may lead to an increase in cerebral blood flow and to a damage of the blood bain barrier with consequent cerebral edema. Urapidil seems to be suitable for treating hypertensive episodes perioperatively in neurosurgical patients.     

Management of increased intracranial pressure in the critically ill child with an acute neurological injury

Increased intracranial pressure reflects the presence of mass effect in the brain and is associated with a poor outcome in children with acute neurological injury. If sustained, it has a negative effect on cerebral blood flow and cerebral perfusion pressure, can cause direct compression of vital cerebral structures, and can lead to herniation. The management of the patient with increased intracranial pressure involves the maintenance of an adequate cerebral perfusion pressure, prevention of intracranial hypertension, and optimization of oxygen delivery. This article reviews the neurological assessment, pathophysiology, and management of increased intracranial pressure in the critically ill child who has sustained an acute neurological injury.     

高血压脑出血术后颅内压增高的护理因素分析及处理

26例高血压脑出血患者术后连续颅内压监护中发生颅内压增高107次,分析出现颅内压增高的护理因素,发现颅内压增高与患者躁动、呼吸机人机对抗、引流管堵塞、吸痰、体位变化等有关。在处理高血压脑出血术后患者的颅内压波动时,应正确分析原因,及时采取合理的护理措施控制颅内压。     

横窦狭窄的影像学研究进展

横窦是颅内静脉回流重要通路,对维持脑循环及稳定颅内压至关重要。横窦狭窄（TSS）为横窦最常见变异,可致窦腔血流动力学及压力变化,与特发性颅高压、搏动性耳鸣及慢性头痛等密切相关。本文对影像学研究TSS进展进行综述。     

Refractory increased intracranial pressure in severe traumatic brain injury: barbiturate coma and bispectral index monitoring

Patients with severe traumatic brain injury resulting in increased intracranial pressure refractory to first-tier interventions challenge the critical care team. After exhausting these initial interventions, critical care practitioners may utilize barbiturate-induced coma in an attempt to reduce the intracranial pressure. Titrating appropriate levels of barbiturate is imperative. Underdosing the drug may fail to control the intracranial pressure, whereas overdosing may lead to untoward effects such as hypotension and cardiac compromise. Monitoring for a therapeutic level of barbiturate coma includes targeting drug levels and using continuous electroencephalogram monitoring, considered the gold standard. New technology, the Bispectral Index monitor, utilizes electroencephalogram principles to monitor the level of sedation and hypnosis in the critical care environment. This technology is now being considered for targeting appropriate levels of barbiturate coma.     

Early effects of nimodipine on intracanial and cerebral perfusion pressures in cerebral anoxia after out-of-hospital cardiac arrest

Some calcium entry blockers seem to improve the neurological survival of anoxic comas. The early monitoring of intracranial pressure shows the frequency of intracranial hypertension. A calcium channel blocker has been shown to increase the cerebral blood flow which can potentially lead to deleterious increases of the intracranial pressure. This study presents 39 out-of-hospital cardiac arrests resuscitated with success. The intracranial pressures were registered by means of an extra dural screw set up as soon as possible. Nineteen patients received an early continuous 5 days nimodipine treatment (0.58 γ/kg weight/min. after a 12.3 γ/kg weight bolus). The other 20 patients did not receive any calcium entry blocker. The two groups were similar in terms of age, origin and electrical type of cardiac arrest, duration of cardiac arrest before BLS and before ACLS, principles of the treatment, initial neurological status and biological values. The maximum and mean intracranial pressures of the nimodipine group were always lower than the intracranial pressure of the control group. The cerebral perfusion pressure was never significantly different in both groups. If the nimodipine treatment proves to be efficient on neurological survival, it would be all the more interesting because it seems to limit the intracranial hypertension phenomenon which aggravates the neurological prognosis.     

Critical care and anesthetic management of Reye's syndrome.

The encephalopathy of Reye's syndrome is frequently complicated by increased intracranial pressure (ICP) which may lead to death or severe neurologic sequelae. An understanding of the pathophysiology of increased ICP is necessary to prevent further increases in pressure and to reduce pressure while maintaining adequate cerebral perfusion. Four of seven children with Reye's syndrome and increased ICP survived after reduction of increased ICP by controlled hyperventilation and osmotherapy while being monitored with the Richmond intracranial bolt. Careful anesthetic and critical-care management, appropriate, reliable monitoring, and pentobarbital therapy may constitute the most successful therapy to date for patients with Reye's syndrome and increased ICP.     

Intracranial hemorrhage after prehospital administration of intramuscular epinephrine

Background

The administration of epinephrine by the intramuscular route can be life-saving in cases of anaphylaxis or severe allergic reactions. However, the use of this drug can lead to a rapid rise in blood pressure, which theoretically could lead to deleterious effects in patients of any age, with elderly patients at greatest risk.

Objectives

To present a rare case of intracranial hemorrhage potentially resulting from the administration of intramuscular epinephrine in an elderly patient with an allergic reaction.

Case Report

We present a case report of a 65-year-old woman who developed an intracranial hemorrhage after a single, therapeutic, intramuscular dose of epinephrine for a wasp sting to the tongue. The patient underwent successful craniotomy with evacuation of the intracranial hematoma.

Conclusions

In circumstances where the severity of the allergic reaction remains unclear (lack of airway compromise, cardiovascular collapse, or true anaphylaxis), careful consideration of the potential risks of intramuscular epinephrine, such as a rapid rise in blood pressure leading to intracranial hemorrhage, should be undertaken when using this medication in elderly patients.     

Comparing the effect of positioning on cerebral autoregulation during radical prostatectomy: a prospective observational study

Journal of Clinical Monitoring and Computing - Surgery in the prolonged extreme Trendelenburg position may lead to elevated intracranial pressure and compromise cerebral hemodynamic regulation. We...     

Cerebro-pulmonary interactions during the application of low levels of positive end-expiratory pressure

Objective In patients with severe brain injury and acute lung injury the use of positive end-expiratory pressure (PEEP) is limited by conflicting results on its effect on intracranial pressure. We hypothesised that the occurrence of alveolar hyperinflation during the application of PEEP would lead to an increase in PaCO₂ responsible for a rise in intracranial pressure.Design Prospective interventional study.Setting Intensive Care Unit of University Hospitals.Patients and participants Twelve severely brain-injured patients with acute lung injury and intracranial pressure higher than applied PEEP.Interventions 5 and 10 cmH₂O of PEEP was randomly applied.Measurements and results In all patients intracranial pressure, flow velocity by transcranial Doppler of middle cerebral artery, and jugular oxygen saturation were recorded. Static volume-pressure curves of the respiratory system were obtained, recruited volume and elastance calculated to classify patients as recruiters and non-recruiters. In recruiters (= 6 patients), elastance decreased (P<0.01) and PaO₂ increased (P<0.005), while in non-recruiters (= 6 patients) elastance and PaCO₂ significantly increased (P<0.001). Intracranial pressure, Doppler flow velocity, and jugular saturation remained constant in recruiters but significantly increased (P<0.0001) in non-recruiters. A significant correlation was found between changes in intracranial pressure and elastance (r² = 0.8 P<0.0001) and between changes in PaCO₂ and intracranial pressure (P<0.001, r² = 0.4) and elastance (P<0.001, r² = 0.4), respectively.Conclusions When PEEP induced alveolar hyperinflation leading to a significant increase in PaCO₂, intracranial pressure significantly increased, whereas when PEEP caused alveolar recruitment intracranial pressure did not change.Supported by Ministero dellUniversità e della Ricerca Scientifica e Tecnologica