Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania 19107, USA.
J Neurosurg. 2011 May;114(5):1479-84. doi: 10.3171/2010.11.JNS091148. Epub 2010 Dec 17.
Follow-up head CT scans are important in neurocritical care but involve intrahospital transport that may be associated with potential hazards including a deleterious effect on brain tissue oxygen pressure (PbtO(2)). Portable head CT (pHCT) scans offer an alternative imaging technique without a need for patient transport. In this study, the investigators examined the effects of pHCT scans on intracranial pressure (ICP), cerebral perfusion pressure (CPP), and PbtO(2) in patients with severe brain injury.
Fifty-seven pHCT scans were obtained in 34 patients (mean age of 42 ± 15 years) who underwent continuous ICP, CPP, and PbtO(2) monitoring in the neuro intensive care unit at a university-based Level I trauma center. Patient ICU records were retrospectively reviewed and physiological data obtained during the 3 hours before and after pHCT scans were examined.
Before pHCT, the mean ICP and CPP were 14.3 ± 7.4 and 78.9 ± 20.2 mm Hg, respectively. Portable HCT had little effect on ICP (mean ICP 14.1 ± 6.6 mm Hg, p = 0.84) and CPP (mean CPP 81.0 ± 19.8 mm Hg, p = 0.59). The mean PbtO(2) was similar before and after pHCT (33.2 ± 17.0 mm Hg and 31.6 ± 15.9 mm Hg, respectively; p = 0.6). Ten episodes of brain hypoxia (PbtO(2) < 15 mm Hg) were observed before pHCT; these episodes prompted scans. Brain hypoxia persisted in 5 patients after pHCT despite treatment. No new episodes of brain hypoxia were observed during or after pHCT.
These data suggest that pHCT scans do not have a detectable effect on a critically ill patient's ICP, CPP, or PbtO(2).
神经危重症监护中，后续头部 CT 扫描很重要，但需要在院内转运，这可能会带来潜在风险，包括对脑组织氧压（PbtO2）产生有害影响。便携式头部 CT（pHCT）扫描提供了一种替代的成像技术，无需患者转运。在这项研究中，研究者检查了 pHCT 扫描对伴有严重脑损伤患者颅内压（ICP）、脑灌注压（CPP）和 PbtO2 的影响。
在一家大学附属一级创伤中心的神经重症监护病房，对 34 名（平均年龄 42±15 岁）接受连续 ICP、CPP 和 PbtO2 监测的患者进行了 57 次 pHCT 扫描。回顾性分析患者 ICU 记录，并检查 pHCT 扫描前后 3 小时的生理数据。
在 pHCT 前，ICP 和 CPP 的平均值分别为 14.3±7.4mmHg 和 78.9±20.2mmHg。pHCT 对 ICP（平均 ICP 14.1±6.6mmHg，p=0.84）和 CPP（平均 CPP 81.0±19.8mmHg，p=0.59）影响不大。pHCT 前后 PbtO2 的平均值相似（分别为 33.2±17.0mmHg 和 31.6±15.9mmHg，p=0.6）。在 pHCT 前观察到 10 次脑缺氧（PbtO2<15mmHg）发作，这些发作促使进行了扫描。尽管进行了治疗，但 pHCT 后仍有 5 名患者持续出现脑缺氧。在 pHCT 过程中和之后，没有观察到新的脑缺氧发作。
这些数据表明，pHCT 扫描对危重症患者的 ICP、CPP 或 PbtO2 没有可检测到的影响。
