| 摘要 |
objective: Cerebral perfusion pressure (CPP)-guided management has become a popular treatment for severe head injury. This paper reports our experience with this disease at Chi-Mei Medical Center. Patients and Methods: From May 2001 through November 2002, 24 patients (15 male and 9 female; 38± 11.7 years: mean ± STD:) with Glasgow Coma Scale (GCS) scores of ≦7 were admitted to the Neurosurgical Intensive Care Unit (GCS:5.3±1.3) of Chi-Mei Medical Center. They were managed with decompressive craniectomy, vascular volume expansion (hydroxyethyl starch or albumin), systemic vasopressors (norepinephrine bitartrate or dopamine), sedation (propofol), muscle relazation (atracurium besylate), mannitol and mild hyperventilation to maintain a minimum cerebral perfusion pressure (CPP) of at least 70 mmHg.
Results: The mean arterial pressure was 97.1± 11.3 mmHg, mean intracranial pressure (ICP) was 21.7±7.1 mmHg, mean central venous pressure was 8.6±2.7 mmHg and the mean CPP was 75.4±10.0 mmHg. The fluid intake was 8,096±2,338.6 mL/day and output was 8,011.1±3,008 mL/day. The major complications were pneumonia (58%), pleural effusion (16.7%), adult respiratory distress syndrome (16.7%), hypernatremia (41.7%) and delayed intracranial hemorrhage (12.5%). The mean Glasgow outcome score was 3.4±1.7 at discharge. The overall mortality rate was 25% and the favorable outvome rate was 58.3%. No patient died of uncontrolled ICP.
Conclusions: These results suggest that maintenance of CPP above 70 mmHg reduced mortality and improved the quality of survival following severe traumatic head injury. Nonetheless, one must keep in mind the simultaneous complications of CPP guided management of severe traumatic head injury. |
