Cross D T, Moran C J, Angtuaco E E, Milburn J M, Diringer M N, Dacey R G
Department of Radiology, Washington University School of Medicine, St Louis, MO, USA.
AJNR Am J Neuroradiol. 1998 Aug;19(7):1319-23.
Intraarterial papaverine infusions are performed to reverse cerebral arterial vasospasm resulting from subarachnoid hemorrhage, but such infusions may lead to increases in intracranial pressure (ICP). This study was undertaken to determine when ICP monitoring is indicated during papaverine treatment.
Seventy-eight vessels were treated in 51 sessions in 28 patients with symptomatic vasospasm. ICP, papaverine doses, and infusion rates were recorded during treatment sessions. The procedural data, Hunt and Hess scores, Fisher grades, Glasgow Coma Scale scores, and ages for all subjects were reviewed and analyzed retrospectively.
Baseline ICP ranged from 0 to 34 mm Hg. With typical papaverine doses of 300 mg per territory and infusion times ranging from 5 to 60 minutes per vessel, ICP increases above baseline during papaverine infusion ranged from 0 to 60 mm Hg. Significant (> or = 20 mm Hg) ICP increases during therapy were observed even in patients with low baseline ICP and with papaverine infused at the slowest rate. Patients with a baseline ICP of more than 15 mm Hg were much more likely to have significant ICP increases than were patients with a baseline ICP of 0 to 15 mm Hg. Hunt and Hess scores, Fisher grades, age, and Glasgow Coma Scale scores on admission and immediately before treatment did not correlate with ICP increases during papaverine infusion. Patients with ICP increases of more than 10 mm Hg during therapy were more likely to experience adverse clinical events than were patients with ICP increases of < or = 10 mm Hg. Reduction in the rate of papaverine infusion, or termination of infusion, resulted in reversal of drug-induced ICP elevation.
ICP monitoring during intraarterial papaverine infusions for cerebral vasospasm is recommended for all patients and is particularly important for patients with elevated baseline ICP. Continuous ICP monitoring facilitates safe and time-efficient drug delivery.
进行动脉内罂粟碱输注以逆转蛛网膜下腔出血所致的脑动脉血管痉挛，但此类输注可能导致颅内压（ICP）升高。本研究旨在确定在罂粟碱治疗期间何时需要进行ICP监测。
对28例有症状性血管痉挛患者的51个疗程中的78条血管进行了治疗。在治疗过程中记录了ICP、罂粟碱剂量和输注速率。对所有受试者的手术数据、Hunt和Hess评分、Fisher分级、格拉斯哥昏迷量表评分及年龄进行回顾性分析。
基线ICP范围为0至34 mmHg。采用每区域300 mg的典型罂粟碱剂量，每支血管输注时间为5至60分钟，罂粟碱输注期间ICP高于基线的升高范围为0至60 mmHg。即使在基线ICP较低且以最慢速率输注罂粟碱的患者中，治疗期间也观察到显著（≥20 mmHg）的ICP升高。基线ICP超过15 mmHg的患者比基线ICP为0至15 mmHg的患者更有可能出现显著的ICP升高。入院时及治疗前即刻的Hunt和Hess评分、Fisher分级、年龄及格拉斯哥昏迷量表评分与罂粟碱输注期间的ICP升高无关。治疗期间ICP升高超过10 mmHg的患者比ICP升高≤10 mmHg的患者更有可能发生不良临床事件。降低罂粟碱输注速率或终止输注可使药物诱导的ICP升高逆转。
建议对所有患者在进行脑动脉血管痉挛的动脉内罂粟碱输注期间进行ICP监测，这对基线ICP升高的患者尤为重要。持续的ICP监测有助于安全且高效地给药。
