Cortbus F, Jones P A, Miller J D, Piper I R, Tocher J L
Department of Clinical Neurosciences, University of Edinburgh, U.K.
Acta Neurochir (Wien). 1994;130(1-4):117-24. doi: 10.1007/BF01405511.
A group of 74 patients with head injury (54 severe, 17 moderate and 3 minor) had continuous monitoring of both arterial and intracranial pressure with computer-based registration of these pressures, cerebral perfusion pressure and other variables. In 60 patients cerebral perfusion pressure CPP fell below 60 mm Hg for periods of 5 minutes or longer. The distribution over time of these reductions in CPP during up to 12 days of monitoring was studied, and each episode of reduced CPP was attributed to a fall in arterial pressure, an increase in intracranial pressure, or both. Two clusters of reduced CPP were found, one during the first 24 hours of monitoring, when reduced CPP was mainly caused by a reduction in arterial pressure, and the other at 5 or 6 days after injury, when reduced CPP was due mainly to an increase in intracranial pressure. There was a significant correlation between low CPP due to reduced arterial pressure and the Injury Severity Score (p < 0.001), suggesting that resuscitative measures may have been less than optimal in these cases. There was also significant correlation between the duration of low CPP and low arterial pressure and an adverse outcome from injury as assessed at 6, 12 and 24 months after injury (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
一组74例头部受伤患者（54例重伤、17例中度伤和3例轻伤）接受了动脉压和颅内压的连续监测，并通过计算机记录这些压力、脑灌注压及其他变量。60例患者的脑灌注压（CPP）降至60毫米汞柱以下持续5分钟或更长时间。研究了在长达12天的监测期间CPP下降的时间分布情况，每次CPP下降均归因于动脉压下降、颅内压升高或两者兼而有之。发现了CPP下降的两个集群，一个在监测的最初24小时内，此时CPP下降主要由动脉压降低引起；另一个在受伤后5或6天，此时CPP下降主要是由于颅内压升高。因动脉压降低导致的低CPP与损伤严重度评分之间存在显著相关性（p<0.001），表明在这些病例中复苏措施可能不够理想。CPP降低持续时间和低动脉压与受伤后6、12和24个月评估的不良损伤结局之间也存在显著相关性（p<0.001）。（摘要截选至250字）
