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1、脑灌注的监测和支持床旁LDF监测rCBF脑灌注压阈值因为有出现ARDS的危险，过分努力用输液和升压药使CPP保持在70mmHg以上应该避免CPP<50mmHg应该避免,CPP的目标范围50-70mmHg,有完整血压自动调节能力的病人可以耐受更高的CPP70mmHg到60mmHg的转变BrainTraumaFoundationGuidelinesforthemanagementofseveretraumaticbraininjuryJNeurotrauma.2007;24Suppl1:S37-44儿童重型
2、颅脑创伤的良好预后指标ICP和CPP是预测儿童重型颅脑创伤不良长期结果的精确指标CarterBG.ICPandCPP:excellentpredictorsoflongtermoutcomeinseverelybraininjuredchildrenChildsNervSyst2008);24:245–251儿童重型颅脑创伤的良好预后指标一项涉及156例1-18岁患儿的回顾性研究结果提示最初的CPP在40-70mmHg之间较CPP过高或过低的患儿神经功能预后好ALBERTCT.Intracranialp
3、ressureandcerebralperfusionpressureasriskfactorsinchildrenwithtraumaticbraininjuriesJNeurosurg(6SupplPediatrics)2007;106:463–466CPP的最低阈值CPP=50mmHg,微透析法监测代谢指标,乳酸、乳酸/丙酮酸比例,结果说明CPP低至50mmhg是安全的,没有缺氧表现NordstromCH,Assessmentofthelowerlimitforcerebralperfusionp
4、ressureinsevereheadinjuriesbybedsidemonitoringofregionalenergymetabolism.Anesthesiology.2003;98(4):805-7.EkerC,Improvedoutcomeaftersevereheadinjurywithanewtherapybasedonprinciplesforbrainvolumeregulationandpreservedmicrocirculation.CritCareMed1998;26:188
5、1–6CPP=MAP-ICPSBP<90mmHg低血压应该避免氧合应该监测，PaO2<60mmHgorO2saturation<90%的低氧应该避免用输液和升压药使CPP保持在70mmHg以上增加ARDS的发生BrainTraumaFoundationGuidelinesforthemanagementofseveretraumaticbraininjuryJNeurotrauma.2007;24Suppl1:S37-44RobertsonCS,ValadkaAB,HannayHJ,etal.Preve
6、ntionofsecondaryischemicinsultsaftersevereheadinjury.CritCareMed1999;27:2086–95CPP=MAP-ICP监测控制颅内压是保持脑灌注压的基础颅内压监测指征所有可挽救的严重TBI病人均应监测颅内压（TBI：复苏后GCS3-8，CT异常；CT异常包括血肿、挫伤、肿胀、脑疝、和基底池受压严重TBI伴CT异常有如下两项或以上者应进行ICP监测：年龄>40,单侧或双侧运动障碍,SBP<90mmHg；BrainTraumaFoundation
7、GuidelinesforthemanagementofseveretraumaticbraininjuryJNeurotrauma.2007;24Suppl1:S37-44ICP监测颅内压监测仪类型最早应用腰穿和脑室穿刺方法目前的金标准为脑室穿刺置管同时可以进行测压和CSF引流，可以随时调零脑实质内监测在监测过程中不能校对，有微小漂移蛛网膜下，硬膜下和硬膜外缺少精确性ShapiroS,Thefiberopticintraparenchymalcerebralpressuremonitorin244pa
8、tients.SurgNeurol1996;45:278-282ICP监测仪应用ICP比例与经济的关系NationAustrianCroatiaandSlovakiaBosniaandMacedoniaChinaGDP(USD)372137724and88032183and26373000ICPmonitoring(%)61542?WalterMauritz,Epidemiology,treatmentandoutcomeofpatient
