严重题脑损伤临床瑞关注问题.pptVIP

严重颅脑损伤临床关注的问题 杭州市第一人民医院 重症医学科 刘长文 脑灌注压监测 监护脑灌注压(CPP)更为重要 脑灌注压(CPP)维持在50~70mmHg是较理想的. (II) 采用补液或血管升压药使 CPP 70mmHg,临床应注意此方法可诱发ARDS. (II) 脑灌注压(CPP)50mmHg死亡率增加. (III). 血压控制现状 脑灌注压阈值： CPP ≥60mmHg(2001-2005) Lund:50mmHg（2003） 但避免：CPP50mmHg 维持 ICP 20 mm Hg 临床控制目标 项目 损伤 严重损伤 目标ICP(mmHg) ＞25 ＞35 ≤20 BP(mmHg) BPs ＜100 ＜90 ≥100 ＞160 ＞180 个体化BPm ＜80 ＜70 个体化 ＞110 ＞120 个体化CPP(mmHg) ＜60 ＜50 ≈60 ＞70 ＞80 ≈60 严重颅脑损伤降压原则:不扩张静脉，不直接影响颅内压(ICP) 不升高颅内压: 尼卡地平 拉贝洛尔 乌拉地尔(压宁定)? 升高颅内压: 硝普钠 硝酸甘油 继发性脑损伤几乎与低氧血症和低血压相关 Department of Pediatrics, University of Utah, Salt Lake City, Utah. Department of Neurological Surgery, University of Washington, Seattle, Washington. Department of Neurological Surgery, Weill Cornell Medical College, New York, New York. Brain Trauma Foundation, New York, New York. Carolinas Rehabilitation, Charlotte, North Carolina. Department of Neurosurgery, Emory University, Atlanta, Georgia. Department of Neurosurgery, San Francisco General Hospital, San Francisco, California. Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon. Seattle Neuroscience Institute, Seattle, Washington. 0Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands. Department of Neurology, University of Cincinnati, Cincinnati, Ohio. Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, . Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York. Deparment of Neurosurgery, Elmhurst Hospital Center, Flushing, New York. Hospital Nacional Professor Alejandro Posadas, Buenos Aires, Argentina. Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsyl