Vuleković P, Momcilović A, Popović L, Gvozdenović L, Kojadinović Z
Neurohirurska klinika, Institut za hirurgiju, Medicinski fakultet, Novi Sad.
Med Pregl. 1996;49(5-6):206-10.
A series of 33 severely head injured patients, Glasgow Coma Scala score 8 or less, was studied prospectively. All patients were treated by the same protocols and by the physician. Intracranial pressure was monitored in all patients by ventricular puncture. Some degree of increased intracranial pressure (more than 10mmHg) was present at admission to the intensive care unit in 52% of cases. Increases in over 20mmHg during the monitoring period were seen in 15 patients (45%). In 5 patients (15%) he was over 20mmHg, but controlled in intensive care unit with combination of dexamethasone, hyperventilation, normothermia, furosemide and mannitol. In this group mortality rate was 80%. In 10 patients (30%) intracranial hypertension was uncontrollable despite intensive measures, in this group all patients died. The mortality rate in patients with intracranial pressure less than 20mmHg during the monitoring period was significantly lower, 25%. Uncontrollable intracranial hypertension is a serious prognostic sign; all affected patients in our series died. Even intracranial pressure more than 20mmHg, which could be controlled, was associated with high mortality rate (80%). By early aggressive treatment based on intracranial pressure monitoring we can diminish the incidence of intracranial hypertension and reduce overall mortality rate in patients with severe head injury.
对33例格拉斯哥昏迷量表评分在8分及以下的重度颅脑损伤患者进行了前瞻性研究。所有患者均按照相同方案由同一位医生进行治疗。所有患者均通过脑室穿刺监测颅内压。52%的患者在入住重症监护病房时存在一定程度的颅内压升高（超过10mmHg）。在监测期间，15例患者（45%）颅内压升高超过20mmHg。5例患者（15%）颅内压超过20mmHg，但在重症监护病房通过地塞米松、过度通气、正常体温、呋塞米和甘露醇联合治疗得到控制。该组死亡率为80%。10例患者（30%）尽管采取了强化措施，但颅内高压仍无法控制，该组所有患者均死亡。监测期间颅内压低于20mmHg的患者死亡率显著较低，为25%。无法控制的颅内高压是一个严重的预后指标；我们系列中的所有受影响患者均死亡。即使颅内压超过20mmHg且可得到控制，也与高死亡率（80%）相关。通过基于颅内压监测的早期积极治疗，我们可以降低重度颅脑损伤患者颅内高压的发生率并降低总体死亡率。
