Hergert M, Salger D, Klett I, Lestin H G
Klinik für Anästhesiologie und Intensivtherapie, Klinikums Schwerin.
Anaesthesiol Reanim. 1998;23(4):99-103.
A therapy refractory brain edema is causally responsible for the death of approximately 50% of patients following severe craniocerebral trauma. The development of a brain edema which cannot be controlled by conservative means is also the most frequent cause of death with cerebral emergencies not caused by trauma. The cerebral perfusion pressure (CPP), which is the decisive factor for sufficient cerebral oxygenation, can be calculated on condition that the mean arterial pressure (MAP) and the intracranial pressure (ICP) are continually monitored: (CPP = MAP-ICP). On the basis of neurological observations, the computer tomographical results and the jugular vein oxymetry, an incipient cerebral decompensation and consequently the failure of the ongoing conservative treatment becomes apparent at an early stage. At this point at the latest, a bitemporal craniectomy should be considered for treatment. A drop in CPP to below 70 mmHg for adults and 50 mmHg for children is regarded as the intervention limits. Our experience shows that the outcome can be improved if the time of the bitemporal craniectomy lies before that of the cerebral decompensation.
难治性脑水肿是导致约50%的重型颅脑创伤患者死亡的直接原因。保守治疗无法控制的脑水肿的发展也是非创伤性脑部急症最常见的死亡原因。脑灌注压（CPP）是充足脑氧合的决定性因素，在持续监测平均动脉压（MAP）和颅内压（ICP）的情况下可进行计算：（CPP = MAP - ICP）。基于神经学观察、计算机断层扫描结果和颈静脉血氧饱和度测定，早期脑代偿失调以及正在进行的保守治疗的失败会变得明显。最迟在此时，应考虑采用双侧颞肌下颅骨切除术进行治疗。成人CPP降至70 mmHg以下、儿童降至50 mmHg以下被视为干预界限。我们的经验表明，如果双侧颞肌下颅骨切除术的时机在脑代偿失调之前，结果可能会得到改善。
