Kocaeli Hasan, Korfali Ender, Taşkapilioğlu Ozgür, Ozcan Tekin
Department of Neurosurgery, Uludağ University School of Medicine, Bursa, Turkey.
Acta Neurochir (Wien). 2008 Dec;150(12):1263-7; discussion 1267. doi: 10.1007/s00701-008-0153-9. Epub 2008 Nov 11.
We aimed to investigate intracranial pressure (ICP) changes during early versus late bedside percutaneous tracheostomy (PT) in a neuro-intensive care unit (NICU).
This study included 30 patients admitted to our NICU for head trauma, subarachnoid haemorrhage, intracerebral haematoma or brain tumour with a Glasgow Coma Score (GCS) less than 8. These patients also underwent ICP monitoring. Bedside PT was performed either early (within 7 days of ventilation) or late (after 7 days of ventilation) via the Griggs system. In all patients; ICP, systemic blood pressure, heart rate, oxygen saturation (Sat O(2)) and arterial blood gases were recorded 5 min before the procedure, during skin incision, during tracheal cannulation, as well as 5 min and 10 min after the procedure.
Thirty patients, 18 male and 12 female, with various intracranial pathologies between ages 18 and 78 (mean 38.7 +/- 20) were identified. The admission GCS ranged between 4 and 11 (median 7). Physiological variables did not differ significantly between the two groups. In the early group, ICP values measured 5 min before the procedure, during skin incision, during tracheal cannulation, as well as 5 min and 10 min after the procedure were 15.1 +/- 5.2, 22 +/- 10.1, 28.4 +/- 13.7, 17.3 +/- 7.1, 13.8 +/- 5.0 mmHg, respectively. In the late group, these values were 14.2 +/- 4.5, 17.2 +/- 5.5, 21.5 +/- 8.0, 15.1 +/- 5.3 and 12.4 +/- 4.1 mmHg. There was no significant difference between the early or late groups in terms of ICP increases during these predetermined 5 time points.
In patients with decreased intracranial compliance, a relatively minimally invasive procedure such as PT may lead to significant increases in ICP. The timing of PT does not seem to influence ICP, mortality, pneumonia or early complications. During the PT procedure, ICP should be closely monitored and preventive strategies should be instituted in an attempt to prevent secondary insult to an already severely injured brain.
我们旨在研究在神经重症监护病房（NICU）中，早期与晚期床边经皮气管切开术（PT）期间的颅内压（ICP）变化。
本研究纳入了30例因头部外伤、蛛网膜下腔出血、脑内血肿或脑肿瘤入住我们NICU且格拉斯哥昏迷评分（GCS）低于8分的患者。这些患者也接受了ICP监测。通过Griggs系统在早期（通气7天内）或晚期（通气7天后）进行床边PT。在所有患者中，在手术前5分钟、皮肤切开时、气管插管时以及手术后5分钟和10分钟记录ICP、全身血压、心率、氧饱和度（Sat O₂）和动脉血气。
确定了30例患者，年龄在18至78岁之间（平均38.7±20），有各种颅内病变，其中男性18例，女性12例。入院时GCS在4至11分之间（中位数7分）。两组之间的生理变量无显著差异。在早期组中，手术前5分钟、皮肤切开时、气管插管时以及手术后5分钟和10分钟测得的ICP值分别为15.1±5.2、22±10.1、28.4±13.7、17.3±7.1、13.8±5.0 mmHg。在晚期组中，这些值分别为14.2±4.5、17.2±5.5、21.5±8.0、15.1±5.3和12.4±4.1 mmHg。在这5个预定时间点，早期或晚期组之间的ICP升高无显著差异。
在颅内顺应性降低的患者中，诸如PT这样相对微创的手术可能会导致ICP显著升高。PT的时机似乎不影响ICP、死亡率、肺炎或早期并发症。在PT手术期间，应密切监测ICP，并应制定预防策略，以防止对已经严重受损的大脑造成二次损伤。
