Synergistic Effect of Staircase Approach on Refractory Intracranial Hypertension in Traumatic Brain Injury: An Illustrative Case Report

階梯式治療對創傷性腦損傷難治性顱內高壓的協同作用：舉例性個案報告

Cheng-Ta Hsieh(謝政達) ； Juey-Ming Shih(施瑞明) ； Jui-Ming Sun(孫瑞明)

《秀傳醫學雜誌》 23卷1期 (2024/04) Pp. 114-122

https://doi.org/10.30185/SCMJ.202404_23(1).0013

摘要

Elevated refractory intracranial pressure poses a frequent challenge in managing severe traumatic brain injury. The staircase approach, encompassing tier zero to three therapies, is reported to effectively reduce elevated intracranial pressure and produce favorable outcomes. However, the synergistic effects of these therapies on intracranial pressure (refractory intracranial hypertension) and cerebral perfusion pressure during the overall treatment period have not been well elucidated. Herein, we report the case of a 32-year-old man who sustained severe traumatic brain injury with refractory intracranial hypertension. After employing several treatment modalities, such as 3% hypertonic saline, target temperature management, and decompressive craniectomy, the patient achieved satisfactory recovery. We analyzed changes in intracranial pressure and cerebral perfusion pressure to assess the synergistic effect of these treatments on increased refractory intracranial pressure.

關鍵字

refractory intracranial hypertension ； decompressive craniectomy ； hypertonic saline ； target temperature management ； traumatic brain injury

並列摘要

難治性顱內壓升高是嚴重創傷性腦損傷治療中常見的問題。據報導，階梯式治療結合了第零級至第三級的處理方法，可降低顱內壓升高並產生良好的結果。然而，這些療法在整個治療期間對顱內壓（難治性顱內高壓）和腦灌注壓的協同作用尚未得到很好的闡明。在此，我們報告了一名32歲男性患有嚴重顱腦外傷並伴有頑固性顱內高壓的病例。經過多種治療方式，包括3%高滲鹽水、目標溫度管理和去骨瓣減壓術，患者獲得了滿意的恢復。我們分析了顱內壓和腦灌注壓的變化，以評估這些治療對增加難治性顱內壓的協同作用。

並列關鍵字

難治性顱內壓增高 ； 去骨瓣減壓術 ； 高滲鹽水 ； 目標溫度管理 ； 創傷性腦損傷

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