Lindvall Peter, Ahlm Clas, Ericsson Mats, Gothefors Leif, Naredi Silvana, Koskinen Lars-Owe D
Department of Neurosurgery, Umeå University Hospital, Umeå, Sweden.
Clin Infect Dis. 2004 Feb 1;38(3):384-90. doi: 10.1086/380970. Epub 2004 Jan 14.
We reported findings concerning continuous intracranial pressure (ICP) and cerebral perfusion pressure (CPP) measurements and mortality in patients with severe bacterial meningitis treated on the basis of an ICP-targeted approach. Eighteen patients with severe bacterial meningitis were admitted for neurointensive care at Umeå University Hospital (Umeå, Sweden). In 15 patients, ICP was measured continuously through an ICP measuring device. During care, all patients but one developed intracranial hypertension with an ICP of >or=15 mm Hg (14 [93%] of 15 patients). Ten (67%) of 15 patients survived and were discharged, and 5 patients (33%) died. Mean ICP was significantly higher and CPP was markedly decreased in nonsurvivors, compared with survivors. Among the survivors, ICP was gradually reduced. Treatment of patients with severe bacterial meningitis should include neurointensive care and continuous ICP measurement. Increased ICP may be reduced by using the ICP-targeted therapy that closely resembles the "Lund concept."
我们报告了以颅内压（ICP）靶向治疗为基础的重症细菌性脑膜炎患者连续颅内压和脑灌注压（CPP）测量结果及死亡率。18例重症细菌性脑膜炎患者入住于瑞典于默奥大学医院（于默奥）接受神经重症监护。其中15例患者通过ICP测量装置连续测量颅内压。在治疗期间，除1例患者外，所有患者均出现颅内高压，颅内压≥15mmHg（15例患者中的14例[93%]）。15例患者中有10例（67%）存活并出院，5例患者（33%）死亡。与存活者相比，非存活者的平均颅内压显著更高，脑灌注压明显降低。在存活者中，颅内压逐渐降低。重症细菌性脑膜炎患者的治疗应包括神经重症监护和连续颅内压测量。采用与“隆德概念”极为相似的ICP靶向治疗可降低升高的颅内压。
