Author/Editor		Strojnik, Tadej
Title		Zdravljenje hudih poškodb možganov s spremljanjem intrakranialnega tlaka in možganskega prekrvitvenega tlaka
Translated title		Treatment of severe brain injuries with monitoring of intracranial pressure and cerebral perfusion pressure
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 69, št. 7-8
Publication year		2000
Volume		str. 509-15
Language		slo
Abstract		Background. Changes concerning the management of severe brain injuries in the last several years have prompted us to join the international study on "Guidelines" which were proposed by the Aitken Neuroscience Center, New York. The neurosurgical department and the department of ICU of the Maribor General Hospital were the participants among other hospital units from the Central Europe. We present 23 patients treated according to Aitken's protocol. Methods. We included patients with a severe brain injury (GCS 8 or less, admitted within 12 hours after the trauma). On admittance the neurological examination and CT scan were carried out. An operative treatment of mass lesion followed if it was necessary. The external liquor drainage was inserted and parenchyma sensor was implanted for intracranial pressure (ICP) monitoring. The arterial pressure was recorded every hour, as well as ICP and cerebral perfusion pressure (CPP) and treated according to monitored values. Twelve hours and ten days after the operation the postoperative CT scans were repeated. The outcome was assessed by Glasgow Outcome Scale (GOS) after 10 days and than one, three and six months later. Results. Twenty-three patients with a severe brain injury (GCS 8 or less) were included. Most (9 of 23) injuries resulted from a fall. Seventeen patients were operated upon intracranial mass lesion. We placed 21 sensors for ICP monitoring. After six months 12 patients are in good condition, 3 patients are in vegetative state. Eight patients died. Conclusions. The outcome following a severe head injury has improved in recentyears. In acute treatment of brain injuries it is necessary for all involved to apply the approaches, as suggested in this contribution.
Summary		Izhodišča. V zadnjih letih so nova spoznanja na področju zdravljenja hude poškodbe možganov prinesla spremembe v pristopu k tem poškodovancem. Aitken Neuroscience Center, New York širi sodobna priporočila "Guidelines for the management of severe head injury" prek mednarodne študije. Vključila se je tudi naša bolnišnica in po njihovem protokolu smo obravnavali 23 poškodovancev. Metode. Vključili smo poškodovance s hudo poškodbo možganov (Glasgowska koma skala (GKS 8 ali manj, sprejeti prej kot v 12 urah po poškodbi). Po začetnem pregledu in CT slikanju glave smo poškodovance po potrebi operativno oskrbeli in napravili zunanjo ventrikularno drenažo. Vstavili smo jim senzor za merjenje intrakranialnega tlaka (IKT). Vsako uro smo beležili izmerjen arterijski tlak, IKT in izračunali možganski prekrvitveni tlak, (MPT) ter ukrepali na osnovi dobljenih vrednosti. Kontrolno CT slikanje smo opravili 12 ur po operaciji in 10. dan po operaciji. Izhod zdravljenja smo ocenjevali 10. dan po poškodbi ter 1, 3 in 6 mesecev po poškodbi z Glasgowsko lestvico izhoda (GLI). Rezultati. Vključili smo 23 bolnikov z GKS ob sprejemu 8 ali manj. Vodilni vzrok za poškodbo je bil padec (9 od 23). Operirali smo 17 bolnikov. Pri 21 bolnikih smo vstavili senzor za merjenje IKT. Osem bolnikov ni preživelo. Po 6 mesecih so trije v vegetativnem slanju, pri 12 pa je izhod dober. Zaključki. Sodoben pristop k hudi poškodbi možganov izboljša možnosti za preživetje in dober izhod pri poškodovancu, zato bi ga morali poznati in uporabljati vsi, ki se srečujemo s temi poškodovanci.
Descriptors		BRAIN INJURIES INTRACRANIAL PRESSURE BLOOD PRESSURE DETERMINATION GLASGOW COMA SCALE TOMOGRAPHY, X-RAY COMPUTED TREATMENT OUTCOME