tailieunhanh - Textbook of Neuroanaesthesia and Critical Care - part 5

Một trong những nguyên tắc cơ bản đằng sau việc thành lập đơn vị chuyên chăm sóc neurointensive rằng sau chấn thương não cấp tính (có thể là từ chấn thương đầu, dưới nhện tự phát hoặc xuất huyết trong não hoặc đột quỵ do thuyên tắc), thiếu máu cục bộ não tiếp tục là một yếu tố quan trọng trong việc xác định kết quả. | Page 157 11 Multimodal Monitoring in Neurointensive Care Pawanjit S. Minhas Peter J. Kirkpatrick Introduction 159 General Considerations Regarding Multimodal Monitoring 159 Monitored Modalities 161 Interfacing Multiple Monitored Modalities 166 Future Developments 166 References 167 Page 159 Introduction One of the key principles behind the establishment of specialist neurointensive care units is that following acute brain injury be it from head trauma spontaneous subarachnoid or intracerebral haemorrhage or embolic stroke continuing cerebral ischaemia is a significant factor in determining outcome. Up to 90 of patients who die from severe head injury have histological evidence of ischaemic brain necrosis at 2 Analysis of the National Institute of Neurological Disease and Stroke Traumatic Coma Data Bank indicates that mortality after severe head injury doubles from 30 in patients who remain normotensive and adequately oxygenated to 60 in those who suffer hypoxaemia or Similarly approximately one-third of all patients with subarachnoid haemorrhage develop clinical signs of delayed ischaemic neurologic deficit probably as a result of cerebral arterial Vasospasm is the most important factor that prevents a good outcome in a patient with good-grade subarachnoid haemorrhage undergoing early clipping of a ruptured cerebral aneurysm. In addition to the high risk of delayed ischaemic neurologic deficit patients with poor-grade subarachnoid haemorrhage often suffer ischaemia from the outset due to increased intracranial pressure reduced cerebral perfusion pressure and blood pressure abnormalities. Contrary to the widely held view that poor-grade subarachnoid haemorrhage patients are unlikely to benefit from aggressive treatment and surgical intervention Le Roux et al were able to demonstrate that 30 of these patients will have good outcome with either no or non-debilitating neurologic deficit if treated aggressively from the By