Keays R T, Alexander G J, Williams R
Institute of Liver Studies, King's College School of Medicine and Dentistry, London, UK.
J Hepatol. 1993 Jun;18(2):205-9. doi: 10.1016/s0168-8278(05)80247-8.
Thirty-six of 68 consecutive patients with fulminant hepatic failure (FHF) progressing to grade 4 encephalopathy who had extradural ICP monitors inserted were reviewed to determine the safety and the value of ICP monitoring. Only minor complications were encountered. These included local wound bleeding at the burrhole site in four patients and a small cerebral hemorrhage in relation to the monitor in one other patient. No significant long-term sequelae were related to the operative procedure. ICP monitoring identified rises in ICP unaccompanied by clinical signs and as a consequence treatment was given to the monitored patients more often than the non-monitored group (median 6 vs. 2 treatments, P < 0.01). The duration of survival from the onset of grade 4 encephalopathy was significantly greater in the ICP monitored group (median 60 vs. 10 h, P < 0.01) although overall survival was unchanged. Monitoring also provided important prognostic information since the peak ICP was higher in non-survivors than in survivors (median 45 vs. 35 mmHg, P = 0.051). The pattern of clinical signs accompanying episodes of intracranial hypertension differed between survivors and non-survivors. Pupillary abnormalities were detected more often in non-survivors while systolic hypertension occurred more frequently amongst survivors with the peak systolic blood pressure being significantly higher. ICP monitoring proved safe and effective, provided valuable information regarding subclinical intracranial hypertension and prognosis and should be regarded as part of the routine management of intracranial hypertension complicating FHF.
对68例连续发生暴发性肝衰竭（FHF）并进展为4级肝性脑病且插入硬膜外颅内压（ICP）监测仪的患者中的36例进行了回顾性研究，以确定ICP监测的安全性和价值。仅出现了轻微并发症。其中包括4例患者在钻孔部位出现局部伤口出血，另有1例患者与监测仪相关的小脑出血。手术操作未导致明显的长期后遗症。ICP监测发现了无临床体征伴随的ICP升高，因此与未监测组相比，接受监测的患者接受治疗的频率更高（中位数分别为6次和2次治疗，P < 0.01）。尽管总体生存率未变，但ICP监测组从4级肝性脑病发作开始的生存时间明显更长（中位数分别为60小时和10小时，P < 0.01）。监测还提供了重要的预后信息，因为非存活者的ICP峰值高于存活者（中位数分别为45 mmHg和35 mmHg，P = 0.051）。存活者和非存活者颅内高压发作时伴随的临床体征模式有所不同。非存活者中瞳孔异常的检测更为常见，而存活者中收缩期高血压更为频繁，收缩压峰值明显更高。ICP监测被证明是安全有效的，提供了有关亚临床颅内高压和预后的有价值信息，应被视为FHF并发颅内高压常规管理的一部分。
