Rabadán Alejandra T, Spaho Natalia, Hernández Diego, Gadano Adrián, de Santibañes Eduardo
Unidad de Transplante Hepático, Servicio de Neurocirugía, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Arq Neuropsiquiatr. 2008 Jun;66(2B):374-7. doi: 10.1590/s0004-282x2008000300018.
Elevated intracranial pressure (ICP) is a common cause of death in acute liver failure (ALF) and is determinant for decision-making regarding the timing of liver transplantation. The recommended type ICP monitoring device is controversial in ALF patients. Epidural devices had less risk of hemorrhagic complications, but they are less reliable than intraparenchymal ones.
Twenty-three patients with ALF were treated, and 19 of them received a liver transplant. Seventeen patients had ICP monitoring because of grade III-IV encephalopathy. All patients received fresh plasma (2-3 units) before and during placing the intraparenchymal device.
Eleven cases (64.7%) had elevated ICP, and 6 patients (35.2%) had normal values. One patient (5.9%) had an asymptomatic small intraparenchymal haemorrhage<1cm3 in CTscan, which did not prevent the liver transplantation.
In our experience, intraparenchymal ICP monitoring in patients with ALF seems to be an accurate method with a low risk of complications.
颅内压（ICP）升高是急性肝衰竭（ALF）患者常见的死亡原因，也是决定肝移植时机的关键因素。对于ALF患者，推荐使用的ICP监测设备存在争议。硬膜外监测设备出血并发症风险较低，但不如脑实质内监测设备可靠。
对23例ALF患者进行治疗，其中19例接受了肝移植。17例因III-IV级脑病接受了ICP监测。所有患者在放置脑实质内监测设备之前及过程中均输注了新鲜血浆（2-3单位）。
11例（64.7%）患者ICP升高，6例（35.2%）患者ICP值正常。1例患者（5.9%）在CT扫描中出现无症状的脑实质内小出血（<1cm3），但这并未妨碍肝移植。
根据我们的经验，对ALF患者进行脑实质内ICP监测似乎是一种准确且并发症风险低的方法。
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