Jo Kwang Wook, Jung Hyun-Ju, Yoo Do Sung, Park Hae-Kwan
Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Anesthesiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Korean Neurosurg Soc. 2021 Nov;64(6):957-965. doi: 10.3340/jkns.2020.0356. Epub 2021 Nov 1.
Rapid increase in intracranial pressure (ICP) can result in hypertension, bradycardia and apnea, referred to as the Cushing phenomenon. During decompressive craniectomy (DC), rapid ICP decreases can cause changes in mean atrial blood pressure (mABP) and heart rate (HR), which may be an indicator of intact autoregulation and vasomotor reflex.
A total of 82 patients who underwent DC due to traumatic brain injury (42 cases), hypertensive intracerebral hematoma (19 cases), or major infarction (21 cases) were included in this prospective study. Simultaneous ICP, mABP, and HR changes were monitored in one minute intervals during, prior to and 5-10 minutes following the DC.
After DC, the ICP decreased from 38.1±16.3 mmHg to 9.5±14.2 mmHg (p<0.001) and the mABP decreased from 86.4±14.5 mmHg to 72.5±11.4 mmHg (p<0.001). Conversly, overall HR was no significantly changed in HR, which was 100.1±19.7 rate/min prior to DC and 99.7±18.2 rate/min (p=0.848) after DC. Notably when the HR increased after DC, it correlated with a favorable outcome (p<0.001), however mortality was increased (p=0.032) when the HR decreased or remained unchanged.
In this study, ICP was decreased in all patients after DC. Changes in HR were an indicator of preserved autoregulation and vasomotor reflex. The clinical outcome was improved in patients with increased HR after DC.
颅内压（ICP）的快速升高可导致高血压、心动过缓和呼吸暂停，即库欣现象。在减压性颅骨切除术（DC）期间，ICP的快速下降可导致平均心房血压（mABP）和心率（HR）发生变化，这可能是自主调节和血管运动反射完好的一个指标。
本前瞻性研究纳入了82例因创伤性脑损伤（42例）、高血压性脑出血（19例）或大面积梗死（21例）而接受DC的患者。在DC期间、之前以及之后5 - 10分钟，每隔一分钟监测ICP、mABP和HR的同步变化。
DC后，ICP从38.1±16.3 mmHg降至9.5±14.2 mmHg（p<0.001），mABP从86.4±14.5 mmHg降至72.5±11.4 mmHg（p<0.001）。相反，HR总体无显著变化，DC前HR为100.1±19.7次/分钟，DC后为99.7±18.2次/分钟（p = 0.848）。值得注意的是，DC后HR升高时，与良好预后相关（p<0.001），然而当HR下降或保持不变时，死亡率增加（p = 0.032）。
在本研究中，所有患者DC后ICP均下降。HR的变化是自主调节和血管运动反射保留的一个指标。DC后HR升高的患者临床结局得到改善。
