Shigemori M, Kawaba T, Yamamoto F, Kawasaki K, Yuge T, Tokutomi T, Nakashima H, Kuramoto S
No Shinkei Geka. 1986 Apr;14(5):637-42.
Efficacy and limitation of barbiturate therapy employed as postoperative treatment for acute traumatic intracranial hematomas were studied in 20 patients. The clinical cases in this series included 15 males and 5 females with mean age of 41.8 years who all were operated on for intracranial hematomas within 3 days after injury. Glasgow Coma Scale (GCS) score was less than 7 in all instances and intracranial pressure (ICP) as well as arterial pressure was monitored postoperatively with Gaeltec and Gould transducers. Barbiturate therapy (5 mg/kg of thiopental as an initial dose and loading dose of 2-3 mg/kg/hour) was given when ICP rose above 20 mmHg and maintained for 3 days after operation. The outcome of the patients was assessed by Glasgow Outcome Scale 3 months after injury. The response of barbiturate on ICP and the changes of cerebral perfusion pressure (CPP) during the therapy in relation to the outcome were studied. Final outcome of the patients revealed 5 of good (good recovery and moderate disability), 3 of poor (severe disability and vegetative state) outcomes and 60% of mortality rate. Eleven out of 20 patients responded to barbiturate therapy and 0-20 mmHg of ICP reduction (mean reduction of 10 mmHg) was obtained in these cases. Among these cases, 2 out of 3 dead patients were older than 60 years. There were no responses of barbiturate in 7 patients to whom the therapy was started when ICP rose above 40 mmHg. No response of the therapy on ICP was also observed in the patients with GCS score of 3.(ABSTRACT TRUNCATED AT 250 WORDS)
对20例急性创伤性颅内血肿患者术后使用巴比妥类药物治疗的疗效和局限性进行了研究。本系列临床病例包括15例男性和5例女性，平均年龄41.8岁，均在受伤后3天内接受了颅内血肿手术。所有患者格拉斯哥昏迷量表（GCS）评分均低于7分，术后使用盖尔泰克和古尔德传感器监测颅内压（ICP）及动脉压。当ICP升至20 mmHg以上时给予巴比妥类药物治疗（硫喷妥钠初始剂量5 mg/kg，维持剂量2 - 3 mg/kg/小时），并在术后维持3天。在受伤3个月后通过格拉斯哥预后量表评估患者的预后。研究了巴比妥类药物对ICP的反应以及治疗期间脑灌注压（CPP）的变化与预后的关系。患者的最终预后显示，5例预后良好（恢复良好和中度残疾），3例预后不良（严重残疾和植物人状态），死亡率为60%。20例患者中有11例对巴比妥类药物治疗有反应，这些病例的ICP降低了0 - 20 mmHg（平均降低10 mmHg）。在这些病例中，3例死亡患者中有2例年龄超过60岁。7例患者在ICP升至40 mmHg以上时开始治疗，对巴比妥类药物无反应。GCS评分为3分的患者对治疗的ICP也无反应。（摘要截断于250字）
