Apuzzo J L, Wiess M H, Petersons V, Small R B, Kurze T, Heiden J S
J Neurosurg. 1977 Feb;46(2):227-32. doi: 10.3171/jns.1977.46.2.0227.
THsi study was designed to define the effect of positive end expiratory pressure (PEEP) ventilation on intracranial pressure (ICP). In 25 patients with severe head trauma with and without associated pulmonary injury the following parameters were simultaneously monitored under mechanical ventilation with and without PEEP:ICP, arterial blood pressure, central venous pressure, arterial blood gases, and cardiac rate. In addition, the volume-pressure response (VPR) was evaluted in each patient to assess cerebral elastance. The results indicate a significant increase in ICP with the application of PEEP only in the 12 patients who manifested increased cerebral elastance by VPR. Half of this latter group manifested impairment of cerebral perfusion pressure to levels less than 60 mm Hg. Return to baseline CIP levels was observed with termination of PEEP. No significantly consistent changes in other parameters were noted.
本研究旨在确定呼气末正压（PEEP）通气对颅内压（ICP）的影响。在25例伴有或不伴有相关肺损伤的重度颅脑外伤患者中，在有和没有PEEP的机械通气下同时监测以下参数：ICP、动脉血压、中心静脉压、动脉血气和心率。此外，评估每位患者的容量-压力反应（VPR）以评估脑弹性。结果表明，仅在通过VPR显示脑弹性增加的12例患者中，应用PEEP后ICP显著升高。后一组中有一半患者的脑灌注压受损至低于60 mmHg的水平。停止PEEP后观察到CIP水平恢复到基线。未观察到其他参数有明显一致的变化。
