Kroppenstedt S N, Kern M, Thomale U W, Schneider G H, Lanksch W R, Unterberg A W
Department of Neurosurgery, Charité, Humboldt-University Berlin, Germany.
J Neurosurg. 1999 Mar;90(3):520-6. doi: 10.3171/jns.1999.90.3.0520.
Although it is generally acknowledged that a sufficient cerebral perfusion pressure (CPP) is necessary for treatment of severe head injury, the optimum CPP is still a subject of debate. The purpose of this study was to investigate the effect of various levels of blood pressure and, thereby, CPP on posttraumatic contusion volume.
The left hemispheres of 60 rats were subjected to controlled cortical impact injury (CCII). In one group of animals the mean arterial blood pressure (MABP) was lowered for 30 minutes to 80, 70, 60, 50, or 40 mm Hg 4 hours after contusion by using hypobaric hypotension. In another group of animals the MABP was elevated for 3 hours to 120 or 140 mm Hg 4 hours after contusion by administering dopamine. The MABP was not changed in respective control groups. Intracranial pressure (ICP) was monitored with an ICP microsensor. The rats were killed 28 hours after trauma occurred and contusion volume was assessed using hematoxylin and eosin-stained coronal slices. No significant change in contusion volume was caused by a decrease in MABP from 94 to 80 mm Hg (ICP 12+/-1 mm Hg), but a reduction of MABP to 70 mm Hg (ICP 9+/-1 mm Hg) significantly increased the contusion volume (p < 0.05). A further reduction of MABP led to an even more enlarged contusion volume. Although an elevation of MABP to 120 mm Hg (ICP 16+/-2 mm Hg) did not significantly affect contusion volume, there was a significant increase in the contusion volume at 140 mm Hg MABP (p < 0.05; ICP 18+/-1 mm Hg).
Under these experimental conditions, CPP should be kept within 70 to 105 mm Hg to minimize posttraumatic contusion volume. A CPP of 60 mm Hg and lower as well as a CPP of 120 mm Hg and higher should be considered detrimental.
尽管人们普遍认为足够的脑灌注压（CPP）对于重型颅脑损伤的治疗是必要的，但最佳的CPP仍存在争议。本研究的目的是探讨不同血压水平以及由此产生的CPP对创伤后挫伤体积的影响。
对60只大鼠的左半球进行控制性皮质撞击伤（CCII）。在一组动物中，伤后4小时通过低压性低血压将平均动脉血压（MABP）降低30分钟至80、70、60、50或40mmHg。在另一组动物中，伤后4小时通过给予多巴胺将MABP升高3小时至120或140mmHg。相应的对照组中MABP未改变。用ICP微传感器监测颅内压（ICP）。创伤发生后28小时处死大鼠，使用苏木精和伊红染色的冠状切片评估挫伤体积。MABP从94mmHg降至80mmHg（ICP 12±1mmHg）时，挫伤体积无显著变化，但MABP降至70mmHg（ICP 9±1mmHg）时，挫伤体积显著增加（p < 0.05）。MABP进一步降低导致挫伤体积进一步增大。尽管MABP升高至120mmHg（ICP 16±2mmHg）对挫伤体积无显著影响，但MABP为140mmHg时挫伤体积显著增加（p < 0.05；ICP 18±1mmHg）。
在这些实验条件下，应将CPP维持在70至105mmHg之间，以尽量减少创伤后挫伤体积。应认为CPP为60mmHg及以下以及120mmHg及以上是有害的。
