Tom 16, Nr 1 (2020)
Artykuł przeglądowy
Opublikowany online: 2020-03-27
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Inwazyjne monitorowanie niedokrwienia mózgu u chorych po urazach czaszkowo-mózgowych
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Pol. Przegl. Neurol 2020;16(1):24-32.
Streszczenie
Monitorowanie wtórnego niedokrwienia mózgu rozpoczyna się we wczesnym okresie po urazie czaszkowo-mózgowym (TBI, traumatic brain injury). Najczęściej stosowaną procedurą jest stały, przyłóżkowy pomiar ciśnienia wewnątrzczaszkowego. Inne możliwości to monitorowanie saturacji krwi żylnej w opuszce żyły szyjnej wewnętrznej, prężności tlenu w mózgu, ocena regionalnego przepływu krwi w mózgowiu oraz mikrodializy. Obecnie brakuje dowodów świadczących o przewadze jednej z opisanych metod; co więcej, nie ma bezspornych dowodów ich przydatności klinicznej. Istnieją jedynie dowody klasy III, według których zaleca się monitorowanie saturacji krwi żylnej w opuszce żyły szyjnej wewnętrznej i prężności tlenu w mózgu podczas głębokiej hiperwentylacji, tj. w przypadkach, w których prężność CO2 jest mniejsza niż 20–25 mm Hg. W pracy omówiono metody inwazyjnej oceny wtórnego niedokrwienia mózgu u chorych po TBI.
Słowa kluczowe: obrzęk mózguciśnienie śródczaszkowesaturacja krwi żylnej w opuszce żyły szyjnej wewnętrznejprężność tlenu w mózguregionalny przepływ mózgowymikrodalizy
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