| 摘要 |
Between December 2002 and October 2003, 30 patients with acute subdural hemorrhage
(SDH) and/or epidural hemorrhage (EDH), and/or intracerebral hemorrhage
(ICH) underwent emergency surgery for hematoma evacuation and were admitted to
our institution, the Neurosurgical Intensive Care Unit of Chi-Mei Medical Center.
The intracranial pressure (ICP) monitor was inserted in the frontal lobe on the lesion
side if the pre-operative Glasgow Coma Scale (GCS) was ≤ 8. The ICP, cerebral perfusion
pressure (CPP) and mean arterial pressure (MAP) were continuously measured
throughout the entire procedure. We encountered three cases where the ICP
was unexpectedly elevated after evacuation of the hematoma with simultaneous
abrupt decreases in CPP to a very low level. The first case had an enlarged ipsilateral
SDH, the second had a subgaleal hemorrhage caused by bleeding in the temporalis
muscle; and the third, a contra-lateral EDH. We suggest that ICP monitoring, especially
intraoperatively, is beneficial for cases of severe head injury, since it facilitates
early detection of ongoing intracranial events such as delayed hemorrhage, and so
that the appropriate emergency procedures can be initiated. |
