重型颅脑损伤早期脑灌注压降低影响因素分析  

ANALYZE ON MONITORING PROTOCOLS OF CEREBRAL PERFUSION PRESSURE IN PATIENTS WITH SEVERE HEAD INJURY

作　　者：李宏宇[1] 赵明光[2] 陈游力[2] 魏学忠[2] 

机构地区：[1]吉林省脑科医院神经外科,吉林省四平市136000 [2]沈阳军区总医院神经外科

出　　处：《中国煤炭工业医学杂志》2007年第10期1144-1145,共2页Chinese Journal of Coal Industry Medicine

摘　　要：目的探讨重型颅脑损伤早期脑灌注压(cerebral perfusion pressure.CPP)降低的影响因素.方法选择伤后72h内首诊入院的重型颅脑损伤患者60例作为研究对象。其中伤后<24h内入院36例,伤后24～72h入院24例,进行持续CPP和同步生理监护,以患者入院时的CPP值分为A组(CPP≥70mmHg)和B组(CPP<70mmHg),根据监测指标的变化给予早期临床干预.结果伤后24h内入院的监护组中,B组患者平均动脉压(mean arterial blcod pressure,MABP)为(62.42±7.01)mmHg、血液PaO_2(60.08±5.99)mmHg.明显低于A组的MABP(95.12±9.16)mmHg和PaO_2(91.66±7.30)mmHg,经统计学比较差异有统计学意义(P<0.05);伤后24～72h入院的监护组中,B组颅内压(intracranial pressure,ICP)为(30.40±5.77)mmHg,较A组(19.22±2.80)mmHg明显增高(P<0.05).结论CPP降低在伤后24h患者与低MABP和低氧血症有关,而伤后24～72h与ICP增高有关;重型颅脑损伤后的早期CPP监护对临床治疗有指导意义。Objective To investigate the monitoring of cerebral perfusion pressure（CPP） and its clinic management in pa-ients with severe head injury. Methods 60 patients with severe head injury were hospitalized within 24 hours（36 cases）or 24-72 hours（24cases）after injury. They were studied with CPP and physiological monitoring methods, and were respectively divided into group A（CPP≥70mmHg）and group B（CPP〈70mmHg）and their management was carried out according to the monitoring protocols. Results In patients hospitalized within 24 hours, the value of mean arterial blood pressure （MABP）and arterial PaO2 was lower in group B.. MABP（62.42 ± 7.01）mmHg; PaO2 （60.08 ± 5. 99）mmHg than that in group A： MABP（95. 12 ± 9. 16） mmHg; PaO2 （91.66 ± 7.30） mmHg. However, the intracranial pressure （ICP） was increased significantly in group B（30.40 ± 5.77）mmHg when compared with that of group A（19.22 ±2.80）mmHg in patients hospitalized in 24-72 hours. Conclusion Provided that all of the monitoring protocols are analyzed exactly, CPP management may not only improves the control of ICP elevation but also the functional survival and outcome of patients with severe head injury.

关 键 词：脑损伤 脑灌注压 颅内压 

分 类 号：R651.15[医药卫生—外科学]