颅内压增高新ppt课件.ppt

容积压力关系 Langtit(1965)在猕猴硬膜外注射液体，每小时1ml同时监测颅压，得出容积压力曲线。 临床许多脑病。脑脓肿，脑积水，慢性硬膜下血肿的病程 经过都是如此。 三主征 头痛 呕吐 视乳头水肿 Cushing反应 Cushing反应，见于颅内压急剧增高，脑血流严重减少，神经反射作用，使心率↓呼吸↓ 血压↑（正常情况下 ：心率↑ 呼吸↑ 血压↑ Cushing反应：心率↓ 呼吸↓ 血压↑ ） Cerebral Haemodynamics 脑疝分为以下常见的三类： ①小脑幕切迹疝又称颞叶沟回疝， ②枕骨大孔疝又称小脑扁桃体疝， ③大脑镰下疝又称扣带回疝。 急性颅内压增高 快速明确诊断 及时处理 抢救——分秒必争 强烈的责任心！！ 课下复习题 1.正常颅内压是多少？何谓颅内压增高？ 2.颅内压增高的原因有哪些？ 3. 颅内压增高的三主征是什么？ 4.颅内压增高的首选辅助检查是什么？ 5.各种脑疝特点和其间的不同表现是什么？ 斯坦福大学胡夫塔 * * * This relationship between ICP, mean arterial pressure (MAP), and cerebral perfusion pressure (CPP) can be appreciated by the equation CPP=MAP-ICP (1). In normal children ICP is 20 mm Hg, and MAP is 70-80 mm Hg, which provides a normal CPP ranging from 50-60 mm Hg (1). Thus, accordingly an increase in ICP, or decrease in MAP can decrease blood flow into the brain. When CPP is 40 mm Hg, ischemia occurs as proper cerebral blood flow (CBF) cannot be maintained (1). This simplified equation attempts to explain a very complicated pathophysiologic process. Controlled by chemical mediators that produce vasoconstriction and vasodilatation of the blood vessels, CBF is constantly changing to meet the brains metabolic demands. The most potent chemical mediator is the arterial partial pressure of carbon dioxide (pCO2), which is directly proportional to CBF. The arterial partial pressure of oxygen (pO2) is indirectly proportional to CBF, but it is not as potent a vasoactive mediator as pCO2. In the acute management of the patient with a severe head injury, these values are manipulated via intubation and mechanical ventilation to maximize CPP. * * * This relationship between ICP, mean arterial pressure (MAP), and cerebral perfusion pressure (CPP) can be appreciated by the equation CPP=MAP-ICP (1). In normal children ICP is 20 mm Hg, and MAP is 70-80 mm Hg, which provides a normal CPP ranging from 50-60 mm Hg (1). Thus, accordingly an increase in ICP, or decrease in MAP can decrease blood flow into the brain. When CPP is 40 mm Hg, isch