Department of Neurological Surgery and Brain Repair, University of South Florida College of Medicine, Tampa, Florida 33606, USA.
Neurosurgery. 2010 Mar;66(3):455-8; discussion 458. doi: 10.1227/01.NEU.0000365517.52586.A2.
Cerebral edema contributes to the high morbidity and mortality of fulminant hepatic failure (FHF).
We report the results of our early experience with insertion of intraparenchymal intracranial pressure (ICP) monitors in these highly coagulopathic patients.
Eleven consecutive patients with FHF met the criteria for invasive ICP monitoring. Recombinant activated factor VII (rFVIIa) was administered at an average dose of 3 mg intravenous bolus (average, 36.7 microg/kg). We inserted the intraparenchymal ICP monitor within 15 minutes to 2 hours after rFVIIa administration, without waiting for the repeat coagulation results. Postprocedure computed tomographic scans of the brain were obtained in all patients.
No hemorrhagic complications were detected on the immediate postprocedure computed tomographic scans. There were no thrombotic complications in this group of patients.
In this group of patients with FHF, placement of an ICP monitor without hemorrhagic or thrombotic complications was feasible after administration of rFVIIa. This is a report of our early experience, and caution is advised. Further collaborative randomized studies are needed to prove the efficacy, optimal dosing, and cost effectiveness of rFVIIa for the placement of ICP monitors in this group of patients.
脑水肿是暴发性肝衰竭（FHF）高发病率和高死亡率的原因。
我们报告了我们在这些高凝血病患者中早期使用脑内颅内压（ICP）监测器的经验结果。
11 例符合侵袭性 ICP 监测标准的 FHF 连续患者入选。重组活化因子 VII（rFVIIa）的平均剂量为 3 毫克静脉推注（平均 36.7 微克/千克）。我们在 rFVIIa 给药后 15 分钟至 2 小时内插入脑内 ICP 监测器，而无需等待重复凝血结果。所有患者均在术后立即进行脑部计算机断层扫描。
即刻术后计算机断层扫描未发现出血性并发症。该组患者无血栓并发症。
在这组 FHF 患者中，rFVIIa 给药后放置 ICP 监测器没有出现出血或血栓并发症是可行的。这是我们早期经验的报告，需要谨慎。需要进一步的协作随机研究来证明 rFVIIa 在这组患者中放置 ICP 监测器的疗效、最佳剂量和成本效益。
