《脑顺应性》PPT课件.ppt

Brain Compliance,邱海波 东南大学附属中大医院重症医学科 东南大学急诊与危重病医学研究所,Background,VTotal =Vtissue+VCSF+Vblood=constant,颅内压（Intracranial Pressure，ICP）,脑组织 80 脑脊液CSF 10 脑血容量CBV 10,80,10,10,成人的颅腔容积固定不变，为1400ml-1500ml,Background,临床还可以通过颅内压监护装置，进行持续地动态观察,一般以侧卧位腰椎穿刺或直接脑室穿刺测量脑脊液的静水压,ICP测量：,收缩期,呼气时,颅内压增高,舒张期,吸气时,颅内压降低,颅内压可在小范围内波动，与血压、呼吸关系密切,40 30 20 10 0,Blood,CSF,Tissues,Masses,Compensatory mechanisms,P,V,Langfilt TW et al, J Neurosurg.1964,COMPLIANCE,Compliance and ICP normal,40 30 20 10 0,Blood,CSF,Tissues,Masses,Compensatory mechanisms,P,V,Langfilt TW et al, J Neurosurg.1964,COMPLIANCE,Compliance reduced and ICP normal,颅内压的调节与代偿,当颅腔总容积超过5时，颅内压开始增高，当颅腔总容积超过810时，则会产生严重的颅内压增高,颅内压增高时，有一部分脑脊液被挤入脊髓蛛网膜下腔，起下调颅内压的作用,脑脊液的总量占颅腔总容积的10，约150ml,COMPENSATION,Slow / Fast,COMPENSATION,Changes in CSF volume,COMPENSATION,Vicious circle,CSF volume shift,40 30 20 10 0,Blood,CSF,Tissues,Masses,Compensatory mechanisms,P,V,Langfilt TW et al, J Neurosurg.1964,Compliance,Compliance exhausted， and ICP increase,COMPENSATION,COMPENSATION,COMPENSATION,Anatomical Correlates Vor ICP Compensation,ICP Wave,ICP Wave,Acta Neurochir (Wien) (2004) 146: 131141,ICP Wave,ICP and CVR,PVI=pressure volume index calculation,ICP=Pbrain+Pblood vessels+PCSF,blood,CSF,Normal,Compensated,Decompensated,ICP7-15mmHg,ICP20-25mmHg,ICP 30mmHg,mass,Brain tissue,mass,Anatomical Correlates Vor ICP Compensation,PVI=