Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109-5048, USA.
J Neurosurg Anesthesiol. 2012 Jan;24(1):58-62. doi: 10.1097/ANA.0b013e31822b4f05.
Maintaining adequate cerebral perfusion pressure (CPP) is of clinical concern in patients with neurological injury. Although there are extensive data on CPP in the ICU setting, there has been little quantitative study of CPP in the intraoperative setting.
We retrospectively analyzed the electronic intraoperative records of neurosurgical and trauma patients with concurrent intracranial and arterial pressure monitoring devices in continuous use for ≥45 minutes to calculate CPP (=mean arterial pressure-intracranial pressure). We assessed the total minutes and frequency of 5-minute epochs, during which the median CPP was <60 mm Hg, and the associated risk factors.
A total of 155 trauma and neurosurgical patients were studied. In the neurosurgery cohort (n=88), 74% had at least one 5-minute epoch during which the median CPP was <60 mm Hg and the median total minutes of CPP<60 mm Hg was 39 [interquartile range (67), length of surgery 274 (300) min]. In the trauma cohort (n=67), 82% had at least one 5-minute epoch of <60 mm Hg, and the median total minutes CPP of <60 mm Hg was 35 [(59), length of surgery 159 (160) min]. For the entire cohort (n=155), patients with CPP<60 mm Hg were found to have higher intracranial pressure compared with patients with CPP≥60 mm Hg (P<0.001). Unlike the neurosurgical cohort, trauma patients with CPP<60 mm Hg had a greater frequency of episodes of mean arterial pressure <70 mm Hg (P=0.001).
CPP<60 mm Hg is common in the intraoperative setting of a tertiary medical center in 2 different surgical populations with intracranial pathology. Prospective studies of intraoperative CPP and neurological outcomes are warranted.
在神经损伤患者中，维持足够的脑灌注压（CPP）是临床关注的问题。尽管 ICU 环境中有大量 CPP 数据，但术中 CPP 的定量研究却很少。
我们回顾性分析了同时使用颅内压和动脉压监测仪的神经外科和创伤患者的术中电子记录，这些患者的监测设备连续使用时间≥45 分钟，以计算 CPP（=平均动脉压-颅内压）。我们评估了中位数 CPP＜60mmHg 的 5 分钟时段的总分钟数和频率，以及相关的危险因素。
共研究了 155 例创伤和神经外科患者。在神经外科组（n=88）中，74%的患者至少有一个 5 分钟时段的中位数 CPP＜60mmHg，中位数 CPP＜60mmHg 的总分钟数为 39[四分位距（67），手术时间 274（300）min]。在创伤组（n=67）中，82%的患者至少有一个 5 分钟时段的 CPP＜60mmHg，中位数 CPP＜60mmHg 的总分钟数为 35[四分位距（59），手术时间 159（160）min]。对于整个队列（n=155），与 CPP≥60mmHg 的患者相比，CPP＜60mmHg 的患者颅内压更高（P＜0.001）。与神经外科组不同，CPP＜60mmHg 的创伤患者平均动脉压＜70mmHg 的发作频率更高（P=0.001）。
在有颅内病变的 2 种不同手术人群的三级医疗中心的术中环境中，CPP＜60mmHg 很常见。需要进行前瞻性研究来评估术中 CPP 与神经结局的关系。
