石广志：脑室穿刺及颅内压监测

颅内压监测首都医科大学北京天坛医医院 ICU 石广志

摘要 ,[object Object],[object Object],[object Object],[object Object],[object Object]

侧脑室穿刺 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

禁忌症 ,[object Object],[object Object],[object Object],[object Object]

侧脑室穿刺 ,[object Object],[object Object],[object Object],[object Object]

额入法 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

枕入法 ,[object Object],[object Object],[object Object]

经前囟法 ,[object Object],[object Object]

注意事项 ,[object Object],[object Object],[object Object],[object Object],[object Object]

保留时间及拔管 ,[object Object],[object Object]

并发症 ,[object Object],[object Object],[object Object],[object Object]

并发症 ,[object Object],[object Object],[object Object],[object Object],[object Object]

颅内压监测指征 ,[object Object],[object Object],[object Object]

颅内压监测可能指征 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

颅内压监测仪类型 ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object]

颅内压力无创评估 ,[object Object],[object Object],[object Object],[object Object],[object Object]

颅内压控制目标 ,[object Object],[object Object],[object Object],[object Object]

颅内压增高控制方法 ,[object Object],[object Object],[object Object]

辅助检查：头 CT （术前）

ICP 增高，怎么办 ,[object Object]

甘露醇降低颅内压的问题 ,[object Object],[object Object],[object Object],[object Object],[object Object]

高渗盐水降低 ICP 原理 ,[object Object],[object Object],[object Object],Betz AL Sodium transport in capillaries isolated from rat brain Neurochem,1983 ， 41(4) ： 1150 ． Fraser PA ． Measurement of filtration coefficient in single cerebral microvessels of the frog. Physiology ， 2004 ， 24 1990 ， 323-343 ．

与甘露醇的比较 ,[object Object],[object Object],[object Object],[object Object],[object Object],Qureshi AL, Treatment of elevated intracranial pressure in experimental intracerebral hemorrhage ： Comparison between mannitol and hypertonic saline J Neurosurgery ， 1999 ， 44 ： 1055-1063 ．

与甘露醇的比较 ,[object Object],[object Object]

临床研究效果 ,[object Object],[object Object],Rockswold GL.HYPERTONIC SALINE AND ITS EFFECT ON INTRACRANIAL PRESSURE, CEREBRAL PERFUSION PRESSURE, AND BRAIN TISSUE OXYGENNEUROSURGERY 2009,65:1035-1042

ICP 变化 ICP 平均下降超过 8.3 mm Hg

CPP 的变化低于 70 mm Hg CPP 平均增加 6 mm Hg

PbtO 2 的变化 PbtO2 平均增加 3.1 mm Hg

副作用 --- 中枢神经系统 ,[object Object],[object Object],Kraus GE. Cerebralspinal fluid endothelin-1 and endothelin-3 levels in normal and neurosurgical patients:a clinical study and literature review. Surg Neurol 1991,35:20-29

副作用 --- 中枢神经系统 ,[object Object],[object Object],[object Object],dams RD ． Central pontine mydindysis ． Principle of neurology ． New York ： McGraw Hill ， 1997 ， 1125 Schell R M.Salt ， starch ， and water on the brain ． J Neurceurg Anesthesiol.1996,8 ： 178 ．

副作用 --- 全身 ,[object Object],[object Object],[object Object],[object Object],[object Object],Suarez Jl ： Editorial comment ： Salting the brain to improve CBF in SAH patients ． Stroke ， 2003 ， 34 ： 1396 ． Vivo P ． Hypertonic saline solution ： a safe alternative to mannitol 18 ％ in neurosurgery ． Minerva—Anesthosiol ， 200l,67 ： 603 Suarez JI ． Treatment of refractory intracranial hypertension with 23.4 ％ saline ． Crit Care Med ， 1998 ， 26 ： Ill8 ．

高渗盐水的优势 ,[object Object],检索 1967 年至 2010 年的相关研究，纳入 5 个研究 112 例病人 184 次 ICP 增高事件，比较甘露醇和高渗盐水的疗效

结论 ,[object Object],[object Object]

局限 ,[object Object],[object Object]

不同的研究结果 ,[object Object],[object Object],Sakellaridis N.Comparison of mannitol and hypertonic saline in the treatment of severe brain injuriesJ Neurosurg 2011 ， 114:545–548

降低 ICP 幅度 ,[object Object],[object Object]

持续时间 ,[object Object],[object Object]

[object Object],[object Object],指南推荐

ICU 容易实施的颅内压增高控制方法 ,[object Object],[object Object],[object Object],[object Object],[object Object]

镇静肌松 ,[object Object],[object Object],[object Object],[object Object],[object Object]

过度通气 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

低温治疗 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

小结 ,[object Object],[object Object],[object Object]

石广志：脑室穿刺及颅内压监测

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石广志：脑室穿刺及颅内压监测

Editor's Notes