Jensen K, Ohrström J, Cold G E, Astrup J
Department of Neuroanaesthesia, Arhus Kommunehospital, Denmark.
Acta Neurochir (Wien). 1991;108(3-4):116-21. doi: 10.1007/BF01418518.
In five head-injured patients with cerebral contusion and oedema in whom it was not possible to control intracranial pressure (ICP) (ICP greater than 20 mmHg) by artificial hyperventilation (PaCO2 level 3.5-4.0 kPa) and barbiturate sedation, indomethacin was used as a vasoconstrictor drug. In all patients, indomethacin (a bolus injection of 30 mg, followed by 30 mg/h for seven hours) reduced ICP below 20 mmHg for several hours. Studies of cerebral circulation and metabolism during indomethacin treatment showed a decrease in CBF at 2 h. After 7 h, ICP remained below 20 mmHg in three patients, and these still had reduced CBF. In the other patients a return of ICP and CBF to pretreatment levels was observed. In all patients indomethacin treatment was followed by a fall in rectal temperature. These results suggest that indomethacin due to its cerebral vasoconstrictor and antipyretic effect should be considered as an alternative for treatment of ICP-hypertension in head-injured patients.
在5例脑挫裂伤伴脑水肿且无法通过人工过度通气（动脉血二氧化碳分压水平3.5 - 4.0 kPa）和巴比妥类药物镇静来控制颅内压（ICP）（ICP大于20 mmHg）的头部受伤患者中，吲哚美辛被用作血管收缩药物。在所有患者中，吲哚美辛（一次静脉推注30 mg，随后以30 mg/h持续7小时）使ICP在数小时内降至20 mmHg以下。吲哚美辛治疗期间的脑循环和代谢研究显示，2小时时脑血流量（CBF）下降。7小时后，3例患者的ICP仍低于20 mmHg，且这些患者的CBF仍降低。在其他患者中，观察到ICP和CBF恢复到治疗前水平。在所有患者中，吲哚美辛治疗后直肠温度下降。这些结果表明，由于吲哚美辛具有脑血管收缩和退热作用，应将其视为头部受伤患者颅内压升高治疗的一种替代方法。
