Tindall G T, Patton J M, Dunion J J, O'Brien M S
Clin Neurosurg. 1975;22:332-63. doi: 10.1093/neurosurgery/22.cn_suppl_1.332.
A practical protocol for evaluating and monitoring head injured patients has been presented. It has been stressed that monitoring is an ongoing process which begins with the initial evaluation and continues throughout the patient's hospital stay. The level of monitoring and thus the parameters to be monitored are determined on an individualized basis according to the patient's clinical status and his level of stupor and coma. It has been suggested that for mild head injuries, adequate monitoring includes periodic evaluation of the neurological status and vital signs; but the more severely injured patients require extensive and frequent monitoring of a large number of clinical and physiological parameters. Among the many parameters, the continuous monitoring of ICP and the respiratory system are perhaps the most useful indicators of the patient's condition. Several methods for continuous ICP monitoring which are readily adaptable to most neurosurgical practices have been discussed. These include the intraventricular catheter, subarachnoid screw, and the closed Rickham reservoir connected to a ventricular catheter. In our institution, the Rickham reservoir has been used to monitor ICP and at the time of this report, satisfactory ICP recordings have been obtained in 27 of 30 head injury patients. Although this method requires a small surgical procedure, we believe that the decreased incidence of infection, the rapid access to ventricular fluid, and its potential for long term monitoring justify its use. Suggestions for monitoring other physiological parameters have also been presented. Particular emphasis has been placed on the management of infants and children with head injuries. The clinical entity of chronic subdural hematoma in infants and children has been used to illustrate the value of ICP monitoring as a guide to further treatment. Finally, we have briefly discussed the place of computers in day to day patient care, research, and monitoring.
本文介绍了一种评估和监测头部受伤患者的实用方案。需要强调的是，监测是一个持续的过程，始于初始评估，并贯穿患者住院全过程。监测水平以及因此需要监测的参数是根据患者的临床状况、昏迷程度个体化确定的。对于轻度头部损伤，建议充分的监测包括定期评估神经状态和生命体征；但伤势较重的患者需要广泛且频繁地监测大量临床和生理参数。在众多参数中，持续监测颅内压（ICP）和呼吸系统可能是患者病情最有用的指标。本文讨论了几种易于应用于大多数神经外科手术的持续ICP监测方法。这些方法包括脑室内导管、蛛网膜下腔螺钉以及连接到脑室内导管的封闭式里克姆贮液器。在我们机构，里克姆贮液器已用于监测ICP，截至本报告撰写时，30例头部受伤患者中有27例获得了满意的ICP记录。尽管这种方法需要一个小手术，但我们认为感染发生率降低、能快速获取脑室液以及其长期监测的潜力证明了其使用的合理性。本文还提出了监测其他生理参数的建议。特别强调了头部受伤婴幼儿的管理。婴幼儿慢性硬膜下血肿的临床情况被用来说明ICP监测作为进一步治疗指导的价值。最后，我们简要讨论了计算机在日常患者护理、研究和监测中的作用。
