顱內壓監測在神經家護重症的應用

許多的神經重症所引起腦部的死亡都和顱內高壓有密切的相關。顱內高壓發生時相對的腦灌流壓下降，腦部的循環便受到影響，當顱內高壓無法控制而腦灌流持續低於四十毫米汞柱時腦部終至缺血而死。因此要避免腦部缺血的發生，顱內壓及腦灌流壓監測便成為目前有效的方法。1970年以來陸陸續續發展出腦室內、硬腦膜外、硬腦膜下、蜘蛛網膜下及腦實質內的顱內壓監測器。美國外科學會建議以腦室內導管測量顱內壓為第一優先考量，因為它所測得的數值準確、可信而且兼具有腦脊髓液引流降低顱內壓的效果。目前美國外科學會甚至在嚴重頭部外傷以及自發性腦內出血的治療指導原則中建議，在嚴重的病患必須使用顱內壓監測，依照盧內壓及腦灌流壓的變化來調整治療的方針，這種思考模式在其他各種神經重症也愈來愈受到重視。如此不僅符合科學實證的精神，同時又能得到較好的臨床效果。

關鍵字

顱內壓監測；腦灌流壓；缺血；神經重症；顱內高壓

並列摘要

Intracranial hypertension is closely related to neurological worsening in many critical illnesses. Cerebral perfusion decreases as the intracranial pressure is raised. Irreversible ischemic change occurs when cerebral perfusion pressure is below 40 mmHg. Monitoring of intracranial and cerebral perfusion pressure is an effective measure to prevent this complication. Since 1970s, different types of intracranial pressure monitors which including intraventricular, epidural, subdural, subarachnoid, and intraparenchymal has been developed. Because of the accuracy, reliability and therapeutic cerebrospinal fluid drainage, intraventricular monitor is still the best of choice. Intracranial pressure monitoring and treatment according to the data obtained is suggested in current guidelines for the treatment of severe head injury and spontaneous intracerebral hemorrhage. The same treatment principle is increasingluy applied to many other neurological critical illnesses as well.

並列關鍵字

intracranial pressure monitor ； cerebral perfusion pressure ； ischemia ； neurological critical illnesses ； intracranial hapertension

國際替代計量

顱內壓監測在神經家護重症的應用

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