Kasoff S S, Lansen T A, Holder D, Filippo J S
Department of Neurosurgery, Westchester County Medical Center, N.Y.
Pediatr Neurosci. 1988;14(5):241-9. doi: 10.1159/000120397.
The management of pediatric patients with severe head trauma often requires aggressive physiologic monitoring and treatment. As intracranial pressure (ICP) increases, so does mortality. Yet attempts to decrease elevated ICP can cause physiologic and hemodynamic problems. In this retrospective analysis of 25 patients treated with ICP monitoring alone, ICP measurements plus mannitol, or ICP measurements plus pentobarbital (PB) induced coma/mannitol, survival rates were higher than predicted, particularly among the most severely injured. These results were apparently due to the intensive care and aggressive monitoring. Although barbiturates are known to decrease ICP, the adverse effects encountered, including hypotension, cardiovascular depression and arrhythmias, often outweigh the benefits. Hemodynamic abnormalities are unpredictable and monitoring with Swan-Ganz catheter is useful in managing patients with PB-induced comas. Many failures of PB therapy in pediatric patients may be related to undiagnosed decreases in cardiac output, resulting in decreased cerebral blood flow, even with well-controlled ICP.
患有严重头部创伤的儿科患者的管理通常需要积极的生理监测和治疗。随着颅内压（ICP）升高，死亡率也会增加。然而，试图降低升高的ICP可能会导致生理和血流动力学问题。在这项对仅接受ICP监测、ICP测量加甘露醇或ICP测量加戊巴比妥（PB）诱导昏迷/甘露醇治疗的25例患者的回顾性分析中，生存率高于预期，尤其是在伤势最严重的患者中。这些结果显然归因于重症监护和积极监测。尽管已知巴比妥类药物可降低ICP，但所遇到的不良反应，包括低血压、心血管抑制和心律失常，往往超过其益处。血流动力学异常不可预测，使用Swan-Ganz导管进行监测有助于管理PB诱导昏迷的患者。儿科患者中许多PB治疗失败可能与未诊断出的心输出量降低有关，即使ICP得到良好控制，这也会导致脑血流量减少。
