急性硬膜下血肿清除手术心血管血流动力学改变.pdf

Neurol Med Chir (Tokyo) 46, 219 ¿225, 2006 Cardiopulmonary Hemodynamic Changes During Acute Subdural Hematoma Evacuation Tomonori TAMAKI, Yoji NODE, Yasuhiro YAMAMOTO *, and Akira TERAMOTO Departments of Neurosurgery and *Critical Care Medicine and Emergency, Nippon Medical School, Tokyo Abstract The aim of this study was to clarify the mechanism of hemodynamic changes leading to intraoperative hypotension during evacuation of acute subdural hematoma. To our knowledge, little data is available about the mechanism of hemodynamic changes during surgical interventions to decrease intracranial pressure after severe head injury. The influence of preoperative hypotension on intraoperative hypotension was examined. Hemodynamic studies (pulmonary artery catheterization) were carried out in 15 patients before and after acute subdural hematoma evacuation. All patients were assessed for hemodynamic parameters, evacuated hematoma volume, and intracranial pressure measurements. Comparison between just before and after evacuation of the hematoma showed that the mean arterial pressure, pulmonary arterial pressure, systemic vascular resistance, pulmonary vascular resistance, central venous pressure, and pulmonary capillary wedge pressure all decreased after hematoma evacuation. However, the cardiac index was unchanged after hematoma evacuation. Mean arterial blood pressure is dependent on the cardiac index and vascular resistance, so the decrease in arterial blood pressure during hematoma evacuation was the result of a decline in vascular resistance. The inf