摘要
目的研究过度通气(HV)对重型颅脑创伤(sTBI)病人的颅内压(ICP)、脑血流(CBF)和脑组织氧分压(PbtO2)的影响。方法20例sTBI(GCS3～8分)病人,伤后2～5dICP超过20mmHg时,应用机械通气法使呼气末二氧化碳分压(PetCO2)维持在27～32mmHg之间30min,同时连续监测ICP、CBF和PbtO2。结果所有病人共进行了46次HV,HV可使ICP明显下降(43/46),而CBF和PbtO2对CO2的反应差异较大,其中大部分试验(38/46)CBF和PbtO2明显下降,但仍然保持在各自的缺血阈值(50AU和10mmHg)之上;5次试验CBF和PbtO2下降低于各自的缺血阈值;3次试验ICP无明显变化,CBF轻度升高,而PbtO2下降。结论HV可降低ICP,但有导致或加重脑缺血的危险,应尽量避免早期长时程应用。HV应在CBF持续监测下应用。
Objective The aim of this study was to investigate the effects of hyperventilation on intracranial pressure, cerebral blood flow and brain tissue partial pressure of oxygen in severe traumatic brain injury. Methods 30-minute periods of hyperventilation(27-32mmHg) were performed on different days (2～5 day after injury)in 20 patients with severe traumatic brain injury who underwent intubation and ventilation when intracranial pressure was great than 20 mmHg. Results 46 tests were performed.Hyperventilation result in a significant reduction in ICP (43/46). The response of CBF and PbtO2 to PaCO2 was widely variable and unpredictable .After 30 minute hyperventilation in most tests (38/46), both CBF and PbtO2 values decreased but remained above the lower limits of normality (50AU and 10mmHg, respectively ).In contrast, CBF and PbtO2 decreased below the lower limits of normality in 5 tests; ICP remained above 20mmHg, CBF increased and PbtO2 decreased in 3 tests. Conclusions Hyperventilation could decrease ICP significantly, but might provoke or exacerbate cerebral ischemia. Hyperventilation should not be used early and long time after traumatic brain injury. Hyperventilation should be performed under continuous monitoring of CBF.
出处
《中华神经外科杂志》
CSCD
北大核心
2004年第6期483-485,共3页
Chinese Journal of Neurosurgery
