Dash Monali, Bithal Parmod K, Prabhakar Himanshu, Chouhan R S, Mohanty Bibek
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
J Neurosurg Anesthesiol. 2003 Jul;15(3):270-3. doi: 10.1097/00008506-200307000-00017.
Although ECG changes in subarachnoid hemorrhage and head injury have been described in adults, they have been rarely reported in children. We present 3 pediatric head-injured patients who developed severe ischemic changes on ECG. Three children (ages 9 months, 2.5 years, and 12 years) were admitted with severe head injury. All of them developed progressive ST segment depression of 4 to 7 mm during the surgical procedure. The first case, a 9-month-old child, also had bradycardia and cardiac arrest following ST depression. He was promptly resuscitated with simultaneous evacuation of extradural hematoma. In the other two cases, ST depression also gradually came up to baseline coinciding with surgical treatment of main pathology. All of the patients were ventilated postoperatively for 36 to 48 hours and discharged with no neurologic deficit. ECG changes and myocardial ischemia in head-injured patients have been attributed to extreme sympathetic stimulation and raised intracranial pressure in adults. But there has been no such systematic study in children. From our observations, we can conclude that ECG changes do occur in children with head injury, although the exact mechanism awaits further evaluation.
虽然蛛网膜下腔出血和头部损伤时的心电图变化在成人中已有描述，但在儿童中却鲜有报道。我们报告3例头部受伤的儿科患者，其心电图出现了严重的缺血性改变。3名儿童（年龄分别为9个月、2.5岁和12岁）因严重头部损伤入院。他们在手术过程中均出现了4至7毫米的进行性ST段压低。第一例为一名9个月大的儿童，在ST段压低后还出现了心动过缓和心脏骤停。他在硬膜外血肿清除的同时迅速复苏。在另外两例中，ST段压低也随着主要病变的手术治疗逐渐恢复到基线水平。所有患者术后均接受了36至48小时的通气，出院时无神经功能缺损。成人头部受伤患者的心电图变化和心肌缺血被归因于极度的交感神经刺激和颅内压升高。但在儿童中尚未有此类系统研究。根据我们的观察，我们可以得出结论，头部受伤的儿童确实会出现心电图变化，尽管确切机制有待进一步评估。
