Pillai S, Praharaj S S, Rao G S U, Kolluri V R S
Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.
Neurol India. 2004 Mar;52(1):67-71.
Cerebral perfusion pressure management (CPPM) is an accepted modality of treatment of severe diffuse head injury (SDHI). However, CPPM has the potential to cause transcapillary exudation in the presence of a disrupted blood brain barrier and can lead to further increase of intracranial pressure (ICP) and worsening of compliance.
This study attempts to evaluate the effect of both transient and prolonged changes in cerebral perfusion pressure (CPP) on ICP and cerebral compliance as measured by the Pressure Volume Index (PVI), and to correlate changes in PVI with outcome at 12 months using the Glasgow Outcome Score.
Prospective study in a neurosurgical ICU.
Twenty-seven SDHI patients managed using standard protocol to maintain CPP above 70 mmHg. Mean arterial pressure (MAP), ICP and CPP were monitored every half-hour. Daily monitoring of the PVI and ICP was done before, and after the induced elevation of MAP using IV Dopamine infusion. The relationship between CPP, MAP, ICP, PVI and outcome was evaluated.
The paired and independent samples T-test, and the Pearson correlation coefficient.
CPPM rarely leads to progressive rise in ICP. Maintaining CPP above 70mmHg does not influence ICP or PVI. Transient elevations in CPP above 70mmHg may produce a small rise in ICP. Trend of change in PVI influenced outcome despite similar ICP and CPP.
Elevating the CPP above 70mmHg does not either reduce the ICP or worsen the compliance. Monitoring changes in compliance should form an integral part of CPPM.
脑灌注压管理（CPPM）是治疗严重弥漫性脑损伤（SDHI）的一种公认方法。然而，在血脑屏障破坏的情况下，CPPM有可能导致跨毛细血管渗出，并可能导致颅内压（ICP）进一步升高和顺应性恶化。
本研究试图评估脑灌注压（CPP）的短暂和长期变化对ICP以及通过压力容量指数（PVI）测量的脑顺应性的影响，并使用格拉斯哥预后评分将PVI的变化与12个月时的预后相关联。
在神经外科重症监护病房进行的前瞻性研究。
27例SDHI患者采用标准方案进行管理，以维持CPP高于70mmHg。每半小时监测平均动脉压（MAP）、ICP和CPP。在使用静脉注射多巴胺输注诱导MAP升高之前和之后，每天监测PVI和ICP。评估CPP、MAP、ICP、PVI与预后之间的关系。
配对和独立样本t检验以及Pearson相关系数。
CPPM很少导致ICP进行性升高。将CPP维持在70mmHg以上不会影响ICP或PVI。CPP短暂升高至7mmHg以上可能会使ICP略有升高。尽管ICP和CPP相似，但PVI的变化趋势影响预后。
将CPP升高至70mmHg以上既不会降低ICP，也不会使顺应性恶化。监测顺应性变化应成为CPPM的一个组成部分。
