当院における重症頭部外傷患者に対するマルチモニタリング

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  • Multi-neuromonitoring of severe traumatic brain injury patients in our hospital

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<p>Objectives: It is important to provide treatment that cor­responds to changes in intracranial pathophysiology after traumatic brain injury (TBI). Neuromonitoring as a means to understand such changes was examined in this study.</p><p>Method: Severe TBI patients with Glasgow Coma Scale scores of 8 or less on admission underwent hypothermia while monitoring intracranial pressure (ICP), jugular venous oxygen saturation (SjO2), and brain temperature. Management of the TBI patients conformed to guidelines. The difference between brain and bladder temperature was defined as ∆T.</p><p>Results: During hypothermia the value of SjO2 in diffuse brain injury patients significantly decreased to 56.6 ± 9.3 (%) in com­parison to evacuated mass patients (75.4 ± 6.4). The average tem­perature when ICP reached its highest value during the re-warming period was 34.9 ± 0.2˚C. Although the required time for re-warming from 34˚C to 35˚C was 56.3 hours, the required time from 35˚C to 36˚C was extended to 75.4 hours. The SjO2 values (%) in three cases in which ICP was 30 mmHg or more during the re-warming period were, respectively, 95, 90 and 48. ICP was controllable after correspondence with hyperemia or ischemia was determined. A significant correlation between ∆T and SjO2 was seen in patients with closed craniums.</p><p>Conclusion: SjO2 measurement in TBI patients is useful for understanding abnormalities in cerebral blood flow and metabolism without high ICP. ICP could be controlled after appropriate treatment that conformed to SjO2 values. The brain and bladder temperature monitoring can provide an index of cerebral blood flow.</p>

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  • 神経外傷

    神経外傷 33 (2), 195-200, 2010-12-27

    一般社団法人 日本脳神経外傷学会

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