hypertension颅内压升高课件

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1、IntracranialHypertension（颅内压增高）Section1Intracranialhypertension(颅内压增高)Intracranialpressure(颅内压)IntracranialPressure(ICP)Thepressurearisingfromthecontentsinsidethecranialcavityagainstthewallofthecranio(skull)Usuallyrepresentedbythepressureinsidethesubaracnoidspaceandmeasuredthroughlumbe

2、rpuncturewhenpatientisplacedinlateraldecubituspositionLumberpunctureMeasurementofintracranialpressureAdult：80－180mmH2O0.7-2.0KPa5-15mmHgChild：50－100mmH2O0.5-1.0KPa(80％ofadult〕INTRACRANIALHYPERTENSIONIntracranialpressurekeepsonhighstatusofmorethan200mmH2O(2.0KPa)EtiologyandPathophysiolo

3、gyofIntracranialhypertensionThecontentsinsidethecranialcavityBrainCerebrospinalfluidBlood(2-11%)1.Intracranialoccupyingdiseases2.VolumeincreaseofthebraintissueBrainedemaLocation:IntracelluerExtracellureSize:LocaleDiffuseEtiology:CytotoxicVasogenicIschemic3.Increaseofthecerebrospinalflu

4、idvolumeAbsorptiondecrease(aracnoidvilli,venoussinus)CirculationdisorderSecretionincrease(Choroidalplexuses)4.IncreaseofthecerebralbloodvolumeInflowincreased:bloodvesselsdilation(CO2cumulation,injuryofthevascularregulationcenterinthehypothalumus,etc.)Outflowoccluded:venousdrainageocclu

5、sion(thrombosisinsidethevenoussinussystem)brainRegulationofintracranialpressure1.Cerebrospinalfluid:Mainfactor:CSFcompressedintospinalcanalIncreaseabsorbtionDecreasesecretion2.Cerebralbloodvolum:AutoregulationandCushing’reactionRegulationofintracranialpressureChangesofbrainbloodflowMAP

6、－ICPCVRCBF＝CPP=MAP－ICPCBF＝CPPCVRCBF:cerebralbloodflow;MAP:meanarterialbloodpressurICP:intracranialpressure;CVR:cerebrovascularresistance;CPP:cerebralperfusionpressure;Cushing’sreactionHypertension、BradycardiaRespirationchangePulsepressureincreaseOthervitalsignschangesvolume/pressurecur

7、veVolume(ml)Pressure(mmH2O)ClinicalManifestationHeadacheVomitusClinicalManifestationPapilledemaClinicalManifestationDiagnosisHistorySignsExaminationsExaminationsLP：measurepressureCT&MRI：occupyingdiseasesDSA：cerebrovasculardiseasesX-rayplanfilmExaminationsICPmonitoringManagementTreatm