每日一题_2022.08.08

A 57-year-old woman is evaluated in the emergency department after sustaining blunt trauma to the right temporal area. Blood pressure is 77/48 mm Hg. Glasgow Coma Scale score is 8. Heart rate is 99 beats/min. Oxygen saturation as measured by pulse oximetry (SpO2) is 88%. Arterial blood gas analysis reveals: PaCO2 55 mm Hg, PaO2 58 mm Hg. Head CT shows no abnormalities.

Which of the following findings would warrant placement of an intracranial pressure monitor?

A. PaO2 of less than 60 mm Hg

B. SpO2 of less than 90%

C. Systolic blood pressure of 77 mm Hg

D. PaCO2 of 55 mm Hg

E. Positive otoscopic examination showing bulging of right tympanum

答案解析：

根据脑外伤基金会，在患有严重颅脑损伤（格拉斯哥昏迷量表评分3-8分）且头部 CT 正常的患者中，颅内压监测的适应症包括以下两种或多种适应症：年龄大于40岁、收缩压小于90 mmHg、单侧或双侧姿势。

正确答案：C

补充内容：前一版（第三版）指南中不符合现行标准的证据支持的推荐

(1) 所有有望挽救生命的 TBI（心肺复苏后 GCS3~8 分）并有异常 CT 结果的患者均应监测 ICP。头颅 CT 异常指发现血肿、挫伤、肿胀、脑疝或基底池受压。

(2) CT 正常的重型 TBI 患者如入院时有两个或以上的以下特征，应行 ICP 监测：年龄超过 40 岁，单侧或双侧的特定运动姿势，或收缩压小于 90 mmHg