小儿脑水肿诊断与治疗的若干问题.pptVIP

小儿脑水肿诊断与治疗的若干问题 脑脊液的总量与分布 无色透明、存在于脑室系统与蛛网膜下腔。 CSF总量 正常成人总量:130~150ml 学龄儿童:80~120ml 幼儿:60~100ml ! 婴儿:40~60ml !! 足月新生儿:10~15ml 颅高压机制 关于ICP 关于ICP Recommendations: 1. Standards. There are insufficient dates to support treatment standards for this topic. 2. Guidelines. There are insufficient dates to support treatment standards for this topic. 3. Options. Treatment for intracranial hypertension, defined as a pathologic elevation in intracranial pressure (ICP), should begin at an ICP≥20mmHg. Interpretation and treatment of intracranial hypertension based on any ICP threshold should be corroborated by frequent clinical examination, monitoring of physiologic variables (e.g., cerebral perfusion pressure), and cranial imaging. Form: Pediatr Crit Care Med 2003 Vol. 4, No. 3(Suppl.) 颅 内 高 压(intracranial hypertension，ICH) 颅内压(ICP)是颅腔内压力与大气压的比较，即颅内压与大气压之差。 正常值(??mmH2O; cmH2O; kPa; mmHg) 新生儿10-20 mmH2O 婴儿30-80 mmH2O 幼儿：40-150 mmH2O 年长儿：60-180 mmH2O 正常成人颅内压80-180 mmH2O， ICH诊断标准（CSF直接测定法）： 新生儿0.78kPa(80mmH2O); 婴幼儿0.98 kPa(100mmH2O); 3岁以上小儿1.96 kPa(200mmH2O) 国外成人: 正常值:50-200mm H2O(3-15mmHg ) 颅内压增高的治疗阈值:=20mmHg (1mmHg=1.36cmH2O ) 颅 内 高 压 急症 比原发病的危害更为严重 具致残性及致死性 脑水肿与颅内高压的关系 病因治疗及抗脑水肿治疗是治疗颅内高压的重要措施 颅内容积代偿 脑脊液(CSF) 颅内血容量(CBV) 当颅内压等于血压时，脑血流也即停止。 脑组织 只有部分的容积代偿。 !! ICP达5．3kPa(40mmHg)时常致脑疝。 代 偿 前囟、颅缝 ！小儿急性脑水肿与颅内高压起病急，进展快，虽有前囟门与颅缝也不一定能代偿 ！年龄愈小，颅内高压的发生率与病死率也愈高 脑血流的自动调节 关于脑灌注压（CPP） Guidelines for Cerebral Perfusion Pressure Recommendations: 1. Standards. There are insufficient date to support treatment standards for this topic. 2. Guidelines. There are insufficient dates to support treatment standards for this topic. 3. Options. Cerebral Perfusion Pressure should be maintained at a minimum of 70mmHg. From: Brain Trauma Foundation American Association of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care ?2000, Brain Trauma Foundation ISBN 0-9703144-0-X 维持足够的CPP Guidelines for Cerebral Perfusion Pressure Recommendati