Gaussorgues P, Piperno D, Fouqué P, Boyer F, Robert D
Ann Fr Anesth Reanim. 1987;6(1):38-41. doi: 10.1016/s0750-7658(87)80008-4.
In three consecutive patients suffering from life-threatening asthma in a comatose state (mean age: 37 +/- 4 yr; Glasgow coma score: 3; bilateral mydriasis), intracranial pressure was monitored with an extradural transducer set-up a mean of 2 h after the onset of the coma. The aims were to detect intracranial hypertension and to improve its therapy. Basal therapy associated: 1) mechanical ventilation; 2) theophylline 1.5 g X 24 h-1, salbutamol 30 mg X 24 h-1, hydrocortisone 2 g X 24 h-1, pancuronium 0.5 mg X kg-1 X 24 h-1; 3) pentobarbitone 35 mg X kg-1 X 24 h-1, normal hydration, normothermia and 30 degrees head-up tilt. If the intracranial pressure rose above 15 mmHg, an i.v. bolus of pentobarbitone (5 mg X kg-1) was given if the barbiturate blood level was equal or below 100 micrograms X l-1. In case of failure, a dose of mannitol (20 mg) completed the therapy if blood therapy was equal or below 320 mosm X l-1. All patients developed intracranial hypertension (21, 53 and 23 mmHg, respectively). The intracranial hypertension followed the bronchospasm and disappeared with it. Hypoxaemia, hypercapnia and high peak airway pressures could explain the intracranial hypertension. All patients recovered without sequelae. This data should make us use with great care all treatments likely to increase the intracranial pressure during life-threatening asthma.
对连续3例处于昏迷状态的危及生命的哮喘患者（平均年龄：37±4岁；格拉斯哥昏迷评分：3分；双侧瞳孔散大），在昏迷开始后平均2小时用硬膜外传感器装置监测颅内压。目的是检测颅内高压并改善其治疗。联合基础治疗：1）机械通气；2）氨茶碱1.5 g×24 h-1、沙丁胺醇30 mg×24 h-1、氢化可的松2 g×24 h-1、泮库溴铵0.5 mg×kg-1×24 h-1；3）戊巴比妥35 mg×kg-1×24 h-1、正常补液、体温正常和头部抬高30度。如果颅内压升至15 mmHg以上，当巴比妥类药物血药浓度等于或低于100 μg×l-1时，静脉推注戊巴比妥（5 mg×kg-1）。如果无效，当血液渗透压等于或低于320 mosm×l-1时，给予一剂甘露醇（20 mg）以完善治疗。所有患者均出现颅内高压（分别为21、53和23 mmHg）。颅内高压随支气管痉挛出现并与之同时消失。低氧血症、高碳酸血症和高气道峰压可解释颅内高压。所有患者均康复且无后遗症。这些数据应使我们在治疗危及生命的哮喘时，极其谨慎地使用所有可能增加颅内压的治疗方法。
