Goetting M G, Preston G
Department of Pediatrics, Henry Ford Hospital, Detroit, Michigan.
Intensive Care Med. 1991;17(4):195-8. doi: 10.1007/BF01709876.
Cerebral venous monitoring through jugular bulb catheterization (JBC) allows assessment of global oxygen delivery adequacy. Because of concern that venous obstruction by catheterization may cause or exacerbate intracranial hypertension, physicians are reluctant to puncture this vessel in brain-injured patients. We evaluated the impact of JBC on intracranial pressure (ICP). 37 consecutive pediatric patients with jugular bulb catheters and ICP monitoring were studied. ICP was monitored in 28 patients during JBC. Also immediately after JBC and daily thereafter the contralateral, ipsilateral, and bilateral jugular veins were compressed in all 37 patients to assess patency of these vessels. Change in ICP was noted. If ICP increased more than 5 torr, compression was stopped. Preinsertion ICP was 17.3 +/- 5.1 and postinsertion 17.2 +/- 5.1 torr. The maximum rise in ICP was 2 torr in a single patient while 6 others had a decrease in ICP. 120 compression tests were performed. Compression ipsilateral to the catheter caused the ICP to rise from 16.0 +/- 4.3 to 18.4 +/- 4.4 torr, and in contralateral compression 15.9 +/- 4.2 to 17.0 +/- 4.4. Neither the duration of catheterization nor the precompression ICP correlated with the rise in ICP. These data revealed no evidence of jugular venous obstruction in the catheterized vessel. We conclude that JBC can be performed in patients without aggravating an elevated ICP.
通过颈静脉球导管插入术（JBC）进行脑静脉监测可评估整体氧输送充足情况。由于担心导管插入导致的静脉阻塞可能会引起或加重颅内高压，医生不愿对脑损伤患者穿刺该血管。我们评估了JBC对颅内压（ICP）的影响。对37例连续的置入颈静脉球导管并进行ICP监测的儿科患者进行了研究。28例患者在JBC期间进行了ICP监测。同样，在JBC后立即以及此后每天，对所有37例患者的对侧、同侧和双侧颈静脉进行压迫，以评估这些血管的通畅性。记录ICP的变化。如果ICP升高超过5托，则停止压迫。插入前ICP为17.3±5.1托，插入后为17.2±5.1托。单个患者的ICP最大升高为2托，而其他6例患者的ICP降低。共进行了120次压迫试验。导管同侧压迫导致ICP从16.0±4.3托升至18.4±4.4托，对侧压迫时从15.9±4.2托升至17.0±4.4托。导管插入持续时间和压迫前ICP均与ICP升高无关。这些数据显示在插入导管的血管中没有颈静脉阻塞的证据。我们得出结论，JBC可在不加重ICP升高的患者中进行。
