Chen Jeff W, Gombart Zoe J, Rogers Shana, Gardiner Stuart K, Cecil Sandy, Bullock Ross M
Department of Neurological Surgery, Legacy Emanuel Hospital, Gantenbein, Portland, OR 97227.
Surg Neurol Int. 2011;2:82. doi: 10.4103/2152-7806.82248. Epub 2011 Jun 21.
This paper introduces the 7/5/2011al Pupil index (NPi), a sensitive measure of pupil reactivity and an early indicator of increasing intracranial pressure (ICP). This may occur in patients with severe traumatic brain injury (TBI), aneurysmal subarachnoid hemorrhage, or intracerebral hemorrhage (ICH).
134 patients (mean age 46 years, range 18-87 years, 54 women and 80 men) in the intensive care units at eight different clinical sites were enrolled in the study. Pupillary examination was performed using a portable hand-held pupillometer.
Patients with abnormal pupillary light reactivity had an average peak ICP of 30.5 mmHg versus 19.6 mmHg for the normal pupil reactivity population (P = 0.0014). Patients with "nonreactive pupils" had the highest peaks of ICP (mean = 33.8 mmHg, P = 0.0046). In the group of patients with abnormal pupillary reactivity, we found that the first evidence of pupil abnormality occurred, on average, 15.9 hours prior to the time of the peak of ICP.
Automated pupillary assessment was used in patients with possible increased ICP. Using NPi, we were able to identify a trend of inverse relationship between decreasing pupil reactivity and increasing ICP. Quantitative measurement and classification of pupillary reactivity using NPi may be a useful tool in the early management of patients with causes of increased ICP.
本文介绍了2011年7月5日的瞳孔指数（NPi），这是一种衡量瞳孔反应性的敏感指标，也是颅内压（ICP）升高的早期指标。这可能发生在重度创伤性脑损伤（TBI）、动脉瘤性蛛网膜下腔出血或脑出血（ICH）患者中。
来自八个不同临床地点重症监护病房的134名患者（平均年龄46岁，范围18 - 87岁，54名女性和80名男性）被纳入研究。使用便携式手持瞳孔计进行瞳孔检查。
瞳孔对光反应异常的患者平均ICP峰值为30.5 mmHg，而瞳孔反应正常的人群为19.6 mmHg（P = 0.0014）。“无反应性瞳孔”的患者ICP峰值最高（平均 = 33.8 mmHg，P = 0.0046）。在瞳孔反应异常的患者组中，我们发现瞳孔异常的首个证据平均出现在ICP峰值前15.9小时。
对可能存在ICP升高的患者使用了自动瞳孔评估。使用NPi，我们能够确定瞳孔反应性降低与ICP升高之间的反向关系趋势。使用NPi对瞳孔反应性进行定量测量和分类可能是早期管理ICP升高病因患者的有用工具。
