Picetti Edoardo, Caspani Maria Luisa, Iaccarino Corrado, Pastorello Giulia, Salsi Pierpaolo, Viaroli Edoardo, Servadei Franco
I Servizio Anestesia Rianimazione, Azienda Ospedaliero Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy.
Neurochirugia e Neurotraumatologia, Azienda Ospedaliero Universitaria di Parma and Arcispedale Santa Maria Nuova di Reggio Emilia, Parma and Reggio Emilia, Italy.
Acta Neurochir (Wien). 2017 Apr;159(4):615-622. doi: 10.1007/s00701-017-3118-z. Epub 2017 Feb 24.
Intracranial pressure (ICP) monitoring represents an important tool in the management of traumatic brain injury (TBI). Although current information exists regarding ICP monitoring in secondary decompressive craniectomy (DC), little is known after primary DC following emergency hematoma evacuation.
Retrospective analysis of prospectively collected data. Inclusion criteria were age ≥18 years and admission to the intensive care unit (ICU) for TBI and ICP monitoring after primary DC. Exclusion criteria were ICU length of stay (LOS) <1 day and pregnancy. Major objectives were: (1) to analyze changes in ICP/cerebral perfusion pressure (CPP) after primary DC, (2) to evaluate the relationship between ICP/CPP and neurological outcome and (3) to characterize and evaluate ICP-driven therapies after DC.
A total of 34 patients were enrolled. Over 308 days of ICP/CPP monitoring, 130 days with at least one episode of intracranial hypertension (26 patients, 76.5%) and 57 days with at least one episode of CPP <60 mmHg (22 patients, 64.7%) were recorded. A statistically significant relationship was discovered between the Glasgow Outcome Scale (GOS) scores and mean post-decompression ICP (p < 0.04) and between GOS and CPP minimum (CPPmin) (p < 0.04). After DC, persisting intracranial hypertension was treated with: barbiturate coma (n = 7, 20.6%), external ventricular drain (EVD) (n = 4, 11.8%), DC diameter widening (n = 1, 2.9%) and removal of newly formed hematomas (n = 3, 8.8%).
Intracranial hypertension and/or low CPP occurs frequently after primary DC; their occurence is associated with an unfavorable neurological outcome. ICP monitoring appears useful in guiding therapy after primary DC.
颅内压（ICP）监测是创伤性脑损伤（TBI）管理中的一项重要工具。尽管目前已有关于二次减压颅骨切除术（DC）中ICP监测的信息，但对于紧急血肿清除术后初次DC后的情况却知之甚少。
对前瞻性收集的数据进行回顾性分析。纳入标准为年龄≥18岁，因TBI入住重症监护病房（ICU）并在初次DC后进行ICP监测。排除标准为ICU住院时间（LOS）<1天和妊娠。主要目标为：（1）分析初次DC后ICP/脑灌注压（CPP）的变化，（2）评估ICP/CPP与神经功能结局之间的关系，以及（3）描述和评估DC后的ICP驱动治疗。
共纳入34例患者。在308天的ICP/CPP监测中，记录到130天至少有1次颅内高压发作（26例患者，76.5%）和57天至少有1次CPP<60 mmHg发作（22例患者，64.7%）。发现格拉斯哥预后量表（GOS）评分与减压后平均ICP之间存在统计学显著关系（p<0.04），以及GOS与CPP最小值（CPPmin）之间存在统计学显著关系（p<0.04）。DC后，持续性颅内高压的治疗方法包括：巴比妥类药物昏迷（n=7，20.6%）、脑室外引流（EVD）（n=4，11.8%）、扩大DC直径（n=1，2.9%）和清除新形成的血肿（n=3，8.8%）。
初次DC后颅内高压和/或低CPP频繁发生；它们的发生与不良神经功能结局相关。ICP监测似乎有助于指导初次DC后的治疗。
