Stocchetti N, Paparella A, Serioli T, Vezzani A, D'Eramo C, Furlan A, Mensi F
I Servizio Anestesia e Rianimazione, USL n. 4, Parma.
Minerva Anestesiol. 1990 Jan-Feb;56(1-2):27-32.
The aim of the intensive care of the injured is the coupling of the availability and the requirement of the cerebral metabolic substates. The measurement of the cerebral blood flow is not currently available at the bedside and less direct monitoring is required. The cerebral perfusion can be estimated looking at the cerebral perfusion pressure (CPP), that can be easily measured using intracranial pressure (ICP) and the systemic arterial pressure (MAP) monitoring. Hundred-twenty-one consecutive head injured admitted to an Intensive Care Unit were studied assessing the severity of the neurological injury, the CT-Scan diagnosis of the intracranial lesion, the Trauma Score and the behavior of the ICP and MAP. The outcome was classified according to a modified version of the Glasgow Outcome Scale. More than 77% of the patients suffered raised intracranial pressure above 20 mmHg and 16 of them had a CPP less than 60 mmHg for more than 5 minutes. The outcome was directly related to the degree of intracranial hypertension and to the severity of insufficient CPP. The treatment of the severe head injured must be aimed at maintaining a good CPP, because of the close relationships between this value and the prognostic result. The monitoring of the ICP is a reliable and relatively safe procedure in this series, where the rate of infections complicating the intracranial recording is less than 3%.
对伤者进行重症监护的目的是使脑代谢亚状态的供应与需求相匹配。目前床旁无法进行脑血流量测量，因此需要进行较少的直接监测。可通过观察脑灌注压（CPP）来估算脑灌注，脑灌注压可利用颅内压（ICP）和体动脉压（MAP）监测轻松测得。对连续收治入重症监护病房的121例头部受伤患者进行了研究，评估神经损伤的严重程度、颅内病变的CT扫描诊断、创伤评分以及ICP和MAP的变化情况。根据改良版格拉斯哥预后量表对结果进行分类。超过77%的患者颅内压升高超过20 mmHg，其中16例患者的CPP低于60 mmHg超过5分钟。结果与颅内高压程度和CPP不足的严重程度直接相关。由于该值与预后结果密切相关，因此对重型颅脑损伤患者的治疗必须旨在维持良好的CPP。在本系列研究中，ICP监测是一种可靠且相对安全的操作，颅内记录并发感染的发生率低于3%。
