腦順應(yīng)性課件

BrainCompliance

腦順應(yīng)性BrainComplianceBackground

VTotal

=Vtissue+VCSF+Vblood=constant腦順應(yīng)性BrainCompliance

顱內(nèi)壓（IntracranialPressure，ICP）

腦組織

80％腦脊液CSF10％腦血容量CBV10％

80％10％10％成人的顱腔容積固定不變，為1400ml-1500ml腦順應(yīng)性BrainComplianceBackground腦順應(yīng)性BrainCompliance臨床還可以通過顱內(nèi)壓監(jiān)護裝置，進行持續(xù)地動態(tài)觀察一般以側(cè)臥位腰椎穿刺或直接腦室穿刺測量腦脊液的靜水壓ICP測量：腦順應(yīng)性BrainCompliance收縮期呼氣時顱內(nèi)壓增高舒張期吸氣時顱內(nèi)壓降低顱內(nèi)壓可在小范圍內(nèi)波動，與血壓、呼吸關(guān)系密切

腦順應(yīng)性BrainCompliance403020100BloodCSFTissuesMassesCompensatorymechanismsPVLangfiltTWetal,JNeurosurg.1964COMPLIANCE

ComplianceandICPnormal腦順應(yīng)性BrainCompliance403020100BloodCSFTissuesMassesCompensatorymechanismsPVLangfiltTWetal,JNeurosurg.1964COMPLIANCE

CompliancereducedandICPnormal腦順應(yīng)性BrainCompliance顱內(nèi)壓的調(diào)節(jié)與代償當(dāng)顱腔總?cè)莘e超過5％時，顱內(nèi)壓開始增高，當(dāng)顱腔總?cè)莘e超過8％～10％時，則會產(chǎn)生嚴重的顱內(nèi)壓增高顱內(nèi)壓增高時，有一部分腦脊液被擠入脊髓蛛網(wǎng)膜下腔，起下調(diào)顱內(nèi)壓的作用腦脊液的總量占顱腔總?cè)莘e的10％，約150ml腦順應(yīng)性BrainComplianceCOMPENSATIONSlow/Fast腦順應(yīng)性BrainComplianceCOMPENSATIONChangesinCSFvolume腦順應(yīng)性BrainComplianceCOMPENSATIONViciouscircleCSFvolumeshift腦順應(yīng)性BrainCompliance403020100BloodCSFTissuesMassesCompensatorymechanismsPVLangfiltTWetal,JNeurosurg.1964Compliance

Complianceexhausted，andICPincrease腦順應(yīng)性BrainComplianceCOMPENSATION腦順應(yīng)性BrainComplianceCOMPENSATION腦順應(yīng)性BrainComplianceCOMPENSATION腦順應(yīng)性BrainComplianceAnatomicalCorrelatesVorICPCompensation

腦順應(yīng)性BrainComplianceICPWave腦順應(yīng)性BrainComplianceICPWaveActaNeurochir(Wien)(2004)146:131–141腦順應(yīng)性BrainComplianceICPWave腦順應(yīng)性BrainComplianceICPandCVR腦順應(yīng)性BrainCompliancePVI=pressurevolumeindexcalculation腦順應(yīng)性BrainComplianceICP=Pbrain+Pbloodvessels+PCSF

bloodCSFNormalCompensatedDecompensatedICP7-15mmHgICP20-25mmHgICP30mmHgmassBraintissuemass腦順應(yīng)性BrainComplianceAnatomicalCorrelatesVorICPCompensation腦順應(yīng)性BrainCompliancePVI=pressurevolumeindexcalculation腦順應(yīng)性BrainCompliancePVIafterTBI腦順