颅内压增高(increasedintracranialpressure)浙江大学.pptVIP

NoticeContent: Clinical practiceTime: 2:00pm this Thursday Address: Department of Neurosurgery, the 8th floor, No.5 Building， No.1, Hospital. Neurosurgery INTRACRANIAL DYNAMICS The first principle is obvious: the cranial cavity has a fixed volume that is filled by various things: 1. Brain tissue2. CSF3. Blood vessels and intravascular blood volume4. Volume associated with any pathologic process, which can include tumor, cyst, abscess, hemorrhage, edema, necrosis A consequence of this principle:If there is an elevation in the volume of any one compartment, there is a stage of compensation in which the volume of one or more other compartments can be reduced to avoid elevations in ICP. QUESTION: What is Intracranial Pressure (ICP)? ICP： the pressure produced by the content of the cranial cavity (brain tissue, CSF and blood) on the cranial cavity wall. Normal ICP： Adult：0.7～2.0 kPa（70～200mmH2O）。 Child：0.5～1.0kPa（50～100mmH2O）。 The second principle is not obvious and may seem counterintuitive: The spinal fluid is produced at a constant rate (～15-20 mL/hr) largely by the choroid plexus of the ventricles by an energy-dependent, physicochemical process. The third basic principle:The cerebral blood flow (CBF) normally varies over a wide range (30-100 mL per 100 g brain tissue per minute), depending on metabolic demand from neuronal activity within a particular area of the brain.  For any brain regionCBF=Cerebral perfusion pressure/ Cerebral vascular resistance The fourth principle:Injured tissue swells, making obvious the potential for a cascading injury by a vicious cycle. If the stage of compensation mentioned earlier, even with therapy, is exceeded and ICP is elevated high enough by whatever mechanism so that cerebral perfusion pressure (CPP) declines, CBF can decline to levels where tissue injury occurs. Cerebral perfusion pressure (CPP)