[1]闫润民,卢亦成,于明琨,等.呼气末正压通气对犬脑内血肿高颅压的影响[J].第三军医大学学报,2007,29(06):513-515.
 YAN Run-min,LU Yi-cheng,YU Ming-kun,et al.Effect of positive end-expiratory pressure on intracranial pressure in dogs with intracerebral hematoma induced intracranial hypertension[J].J Third Mil Med Univ,2007,29(06):513-515.
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
29卷
期数:
2007年第06期
页码:
513-515
栏目:
论著
出版日期:
2007-03-30

文章信息/Info

Title:
Effect of positive end-expiratory pressure on intracranial pressure in dogs with intracerebral hematoma induced intracranial hypertension
作者:
闫润民卢亦成于明琨楼美清张光霁朱诚
解放军总医院第一附属医院神经外科;第二军医大学长征医院神经外科
Author(s):
YAN Run-min LU Yi-cheng YU Ming-kun LOU Mei-qing ZHANG Guang-ji ZHU Cheng
Department of Neurosurgery, The First Affiliated Hospital of General Hospital of PLA, Beijing 100037, Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
关键词:
颅内压呼气末正压脑内血肿
Keywords:
intracranial pressure positive end-expiratory pressure intracerebral hematoma
分类号:
R-332;R363.12;R743.34
文献标志码:
A
摘要:
目的     观察不同水平呼气末正压通气(positive end-expiratory pressure,PEEP)对犬额叶脑内血肿颅内高压的影响。     方法     18只犬随机分为正常颅压组(Ⅰ组,颅内压<18 mmHg)、颅压中度增高组(Ⅱ组,颅内压25~40 mmHg)和颅压高度增高组(Ⅲ组,颅内压>40 mmHg)3组(每组各6只),全麻,气管切开插管,应用肌松剂,机械通气,右额叶脑内注入自体血制成颅内高压模型,PEEP从0开始每次增加3 cmH2O,直到18 cmH2O,每个水平持续20 min,在对侧用光纤颅内压探头监测脑内颅内压(ICP)的变化,记录平均动脉压(MAP)和中心静脉压(CVP)并计算出脑灌注压(CPP)。     结果     随着PEEP的递增,Ⅰ组颅内压上升,脑灌注压下降;Ⅱ、Ⅲ组颅内压略有下降,但Ⅱ组MAP、CPP上升,而Ⅲ组MAP下降,CPP下降;3组CVP都随PEEP增加而升高,但Ⅲ组上升幅度明显大于另两组(P<0.01)。     结论     应用PEEP通气时由于中心静脉压升高、脑静脉回流受阻和血流动力学改变,进而影响ICP和CPP。在正常颅内压状态下,PEEP使颅内压上升,在已有颅内高压存在时,PEEP对颅内压影响不明显,但在重度高颅压情况下,PEEP使CPP明显下降,提示在重度颅内高压需要应用PEEP通气时必须维持MAP,以保证足够的CPP。
Abstract:
Objective     To evaluate the influence of positive end-expiratory pressure (PEEP) on intracranial pressure and cerebral perfusion pressure in dogs with or without intracranial hypertension caused by frontal intracerebral hematoma.      Methods     Eighteen dogs were randomly divided into three groups. In Group B and Group C, the intracranial hypertension was respectively higher than 25 mmHg but less than 40 mmHg and higher than 40 mmHg induced by autoblood clotting injection into the right frontal lobe, while Group A as control was of normal intracranial pressure. PEEP was applied in increment of 3 cmH2O from 0 to 18 cmH2O, each level lasting 20 min. The intracranial pressure (ICP) was monitored by an optical fiber transducer implanted into left frontal lobe. Mean arterial pressure (MAP), heart rate (HR), and central venous pressure (CVP) were recorded simultaneously. Cerebral perfusion pressure (CPP) was calculated by the equation (CPP=MAP-ICP).      Results     With increasing PEEP level, ICP increased and CPP fell in Group A; ICP fell, MAP and CPP increased in Group B; ICP fell, MAP and CPP increased in Group C. CVP increased in all groups, and the increment was significantly higher in Group C than the other two groups (P<0.01).       Conclusion     During PEEP, the alteration of ICP and CPP results from CVP increase, delayed blood return from brain vein and hemodynamic change. ICP increased when PEEP level rose under normal intracranial pressure, but showed no changes under intracranial hypertension, even decreased under severe intracranial hypertension, indicating MAP should be carefully maintained when under severe intracranial hypertension in order to guarantee the adequate CPP.

参考文献/References:

闫润民,卢亦成,于明琨,等. 呼气末正压通气对犬脑内血肿高颅压的影响[J]. 第三军医大学学报,2007,29(6):513-515.

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更新日期/Last Update: 2008-10-29