2022年医学专题—脑灌注的监测和支持.pptVIP免费

脑灌注的监测(jiāncè)和支持首都医科大学附属(fùshǔ)北京天坛医院ICU石广志第一页，共三十六页。灌注压监测CPP=MAP-ICPCPP=MAP-ICP血流监测TCDTCD、、LDFLDF(rCBF)(rCBF)、局部热稀释、局部热稀释清除清除(qīngchú)(qīngchú)法、法、PETPET、、SPECTSPECT第二页，共三十六页。第三页，共三十六页。因为有出现ARDS的危险，过分努力用输液和升压药使CPP保持在70mmHg以上应该避免CPP<50mmHg应该避免,CPP的目标范围50-70mmHg,有完整(wánzhěng)血压自动调节能力的病人可以耐受更高的CPP70mmHg到60mmHg的转变BrainTraumaFoundationGuidelinesforthemanagementofseveretraumaticbraininjuryJNeurotrauma.2007;24Suppl1:S37-44第四页，共三十六页。ICP和CPP是预测儿童重型颅脑创伤不良(bùliáng)长期结果的精确指标CarterBG.ICPandCPP:excellentpredictorsoflongtermoutcomeinseverelybraininjuredchildrenChildsNervSyst2008);24:245–251第五页，共三十六页。一项涉及156例1-18岁患儿的回顾性研究结果提示(tíshì)最初的CPP在40-70mmHg之间较CPP过高或过低的患儿神经功能预后好ALBERTCT.IntracranialpressureandcerebralperfusionpressureasriskfactorsinchildrenwithtraumaticbraininjuriesJNeurosurg(6SupplPediatrics)2007;106:463–466第六页，共三十六页。CPP=50mmHg,微透析法监测(jiāncè)代谢指标,乳酸、乳酸/丙酮酸比例,结果说明CPP低至50mmhg是安全的,没有缺氧表现NordstromCH,Assessmentofthelowerlimitforcerebralperfusionpressureinsevereheadinjuriesbybedsidemonitoringofregionalenergymetabolism.Anesthesiology.2003;98(4):805-7.EkerC,Improvedoutcomeaftersevereheadinjurywithanewtherapybasedonprinciplesforbrainvolumeregulationandpreservedmicrocirculation.CritCareMed1998;26:1881–6第七页，共三十六页。SBP<90mmHg低血压应该避免氧合应该监测，PaO2<60mmHgorO2saturation<90%的低氧应该避免用输液和升压(shēnɡyā)药使CPP保持在70mmHg以上增加ARDS的发生BrainTraumaFoundationGuidelinesforthemanagementofseveretraumaticbraininjuryJNeurotrauma.2007;24Suppl1:S37-44RobertsonCS,ValadkaAB,HannayHJ,etal.Preventionofsecondaryischemicinsultsaftersevereheadinjury.CritCareMed1999;27:2086–95第八页，共三十六页。监测控制(kòngzhì)颅内压是保持脑灌注压的基础第九页，共...