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ID:19803816
大小:2.76 MB
页数:44页
时间:2018-10-06
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1、IntracranialHypertension(颅内压增高)Section1Intracranialhypertension(颅内压增高)Intracranialpressure(颅内压)IntracranialPressure(ICP)Thepressurearisingfromthecontentsinsidethecranialcavityagainstthewallofthecranio(skull)Usuallyrepresentedbythepressureinsidethesubaracnoidspaceandmeasuredthroughlumbe
2、rpuncturewhenpatientisplacedinlateraldecubituspositionLumberpunctureMeasurementofintracranialpressureAdult:80-180mmH2O0.7-2.0KPa5-15mmHgChild:50-100mmH2O0.5-1.0KPa(80%ofadult〕INTRACRANIALHYPERTENSIONIntracranialpressurekeepsonhighstatusofmorethan200mmH2O(2.0KPa)EtiologyandPathophysiolo
3、gyofIntracranialhypertensionThecontentsinsidethecranialcavityBrainCerebrospinalfluidBlood(2-11%)1.Intracranialoccupyingdiseases2.VolumeincreaseofthebraintissueBrainedemaLocation:IntracelluerExtracellureSize:LocaleDiffuseEtiology:CytotoxicVasogenicIschemic3.Increaseofthecerebrospinalflu
4、idvolumeAbsorptiondecrease(aracnoidvilli,venoussinus)CirculationdisorderSecretionincrease(Choroidalplexuses)4.IncreaseofthecerebralbloodvolumeInflowincreased:bloodvesselsdilation(CO2cumulation,injuryofthevascularregulationcenterinthehypothalumus,etc.)Outflowoccluded:venousdrainageocclu
5、sion(thrombosisinsidethevenoussinussystem)brainRegulationofintracranialpressure1.Cerebrospinalfluid:Mainfactor:CSFcompressedintospinalcanalIncreaseabsorbtionDecreasesecretion2.Cerebralbloodvolum:AutoregulationandCushing’reactionRegulationofintracranialpressureChangesofbrainbloodflowMAP
6、-ICPCVRCBF=CPP=MAP-ICPCBF=CPPCVRCBF:cerebralbloodflow;MAP:meanarterialbloodpressurICP:intracranialpressure;CVR:cerebrovascularresistance;CPP:cerebralperfusionpressure;Cushing’sreactionHypertension、BradycardiaRespirationchangePulsepressureincreaseOthervitalsignschangesvolume/pressurecur
7、veVolume(ml)Pressure(mmH2O)ClinicalManifestationHeadacheVomitusClinicalManifestationPapilledemaClinicalManifestationDiagnosisHistorySignsExaminationsExaminationsLP:measurepressureCT&MRI:occupyingdiseasesDSA:cerebrovasculardiseasesX-rayplanfilmExaminationsICPmonitoringManagementTreatm
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