颅脑外伤治疗中脑灌注压的研究。

P O Grände, B Asgeirsson, C Nordström
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引用次数: 30

摘要

目前,在创伤后脑水肿的治疗过程中,血管加压剂主动提高脑灌注压,以改善脑氧合。在本文中,我们认为,如果血脑屏障为溶质打开,动脉压力可以不加批判地提高,因为随后的流体静力毛细血管压力的增加可能有利于经毛细血管过滤。此外,使用血管收缩药物来增加灌注压力实际上可能会损害脑挫伤周围半暗带的氧合,也会损害身体其他组织的氧合,如肠粘膜和肾脏。另一种治疗的概念,既确保足够的大脑氧合和控制颅内压(ICP)给出。简而言之,它意味着积极的抗应激和镇静治疗,充分的血液和胶体液体治疗使血红蛋白和白蛋白值正常,人工通气使PaCO2和PaO2正常,并与降压和儿茶酚胺减少治疗联合使用- 2激动剂和- 1拮抗剂。
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Aspects on the cerebral perfusion pressure during therapy of a traumatic head injury.

An actively raised cerebral perfusion pressure by vasopressors is nowadays often advocated during therapy of a post traumatic brain oedema to improve oxygenation of the brain. In this paper we argue that the arterial pressure not uncritically can be raised as the subsequent increase in hydrostatic capillary pressure may favour transcapillary filtration if the blood-brain barrier is opened for solutes. Further, the use of vasoconstrictor drugs to increase the perfusion pressure may in fact impair oxygenation to the penumbra zones around brain contusions but also to other tissues of the body, like the intestinal mucosa and the kidney. An alternative therapeutical concept which both ensures an adequate oxygenation of the brain and controls the intracranial pressure (ICP) is given. In short, it implies active antistress and sedative treatment, adequate fluid therapy with blood and colloids to normal haemoglobine and albumin values, artificial ventilation to normal PaCO2 and PaO2, and this in combination with antihypertensive and catecholamine reducing treatment with alpha 2-agonist and beta 1-antagonist.

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Abstracts from the Scandinavian Society of Anaesthesiologists, 30th Congress, 10-13 June 2009, Odense, Denmark. Abstracts from the 29th Congress of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine, 5-8 September 2007, Goteborg, Sweden. CHAPTER 7 – Brain Resuscitation Abstracts from the 28th Congress of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine, Reykjavik, Iceland. Abstracts from the 27th Congress of The Scandinavian Society of Anaesthesiology and Intensive Care Medicine. August 16-20, 2003, Helsinki, Finland.
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