Procaccio F, Menasce G, Sacchi L, Boselli L
Reparto di Neurorianimazione, Ospedale Niguarda-Ca Granda, Milano.
Agressologie. 1991;32(8-9 Spec No):381-5.
The effects on intracranial pressure (ICP), cerebral perfusion pressure (CPP) and EEG monitored by Cerebral Function Monitor (CFM) were compared after bolus administration of mannitol (n = 55) and thiopentone (n = 67) to control intracranial hypertension in 18 severely head injured patients. Mannitol increased CPP in 89% of occasions and thiopentone in only 54% (p < 0.001). Thiopentone caused a mean increase in CPP +0.6 kPa (+5.0 +/- 1.6 mmHg) when the minimum pre-bolus voltage of CFM was above 4 microV and a fall in CPP -0.5 kPa (-4.1 +/- 1.6 mmHg) when cortical electrical activity was already severely depressed (p < 0.0002). When pre-bolus CFM was below 4 microV mannitol was superior to thiopentone. This different effect on CPP was due to a significantly greater fall in mean arterial pressure in the thiopentone sub-group -1.6 versus -0.3 kPa (-12.4 +/- 1.5 mmHg, -2.8 +/- 1.2 mmHg; p < 0.001). Severe and unpredictable hypotension occurred, particularly in the thiopentone low CFM sub-group. This symptomatic therapy seems inadequate but a targeted treatment of intracranial hypertension could be possible only with a more sophisticated monitoring, including continuous data on cerebral blood flow and adequacy to metabolic demand.
在18例重度颅脑损伤患者中，比较了单次静脉注射甘露醇（n = 55）和硫喷妥钠（n = 67）以控制颅内高压后，对颅内压（ICP）、脑灌注压（CPP）以及通过脑功能监测仪（CFM）监测的脑电图的影响。甘露醇在89%的情况下可升高CPP，而硫喷妥钠仅在54%的情况下有此作用（p < 0.001）。当CFM的最低推注前电压高于4μV时，硫喷妥钠使CPP平均升高+0.6 kPa（+5.0±1.6 mmHg），而当皮质电活动已严重受抑时，CPP下降-0.5 kPa（-4.1±1.6 mmHg）（p < 0.0002）。当推注前CFM低于4μV时，甘露醇优于硫喷妥钠。对CPP的这种不同影响是由于硫喷妥钠亚组的平均动脉压下降幅度明显更大——-1.6 kPa 对比 -0.3 kPa（-12.4±1.5 mmHg，-2.8±1.2 mmHg；p < 0.
