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Intrakranielle Druck-Volumen-Beziehung

Physiologie und Pathophysiologie

Intracranial pressure-volume relationship

Physiology and pathophysiology

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Zusammenfassung

Die posttraumatische Hirndrucksteigerung hat einen signifikanten Einfluss auf die Prognose nach einem Schädel-Hirn-Trauma. Nach Ausschöpfung sämtlicher Kompensationsmöglichkeiten steigt der Hirndruck exponentiell an [Normwert des intrakraniellen Drucks (ICPnorm)=(Liquorproduktionsrate*Liquorabflusswiderstand)+venöser Druck(sinus sagittalis)=10–15 mmHg)]. Die ICP-Kurve wird durch die Dehnbarkeit des Gehirns („compliance“ ΔV/ΔP) und durch die Elastizität (ΔP/ΔV) beeinflusst. Marmarou konnte zeigen, dass die nichtlineare kraniospinale Druck-Volumen-Beziehung eine logarithmisch, monoexponentielle streng lineare Beziehung des Drucks zum Volumen beschreibt und bezeichnete diese als Druck-Volumen-Index [„pressure volume index“ (PVI)=log ICP/ΔV]. Der Druck-Volumen-Index beschreibt das benötigte Volumen, um den ICP um das Zehnfache zu erhöhen. Alternativ zur Messung des PVI wurde die Messung der Volumen-Druck-Antwort („volume-pressure response“, VPR) eingeführt. Nach dem Prinzip einer pulsatilen Volumenzunahme als Äquivalent einer sehr kleinen intrakraniellen Volumenzunahme kann die kontinuierliche intrakranielle Compliance bestimmt werden. Um jedoch den tatsächlichen Funktionszustand des geschädigten Gehirns zu ermitteln, liefert erst die Kombination verschiedener Messparameter [partieller Gewebesauerstoffpartialdruck (ptiO2), „cerebral blood flow“ (CBF), Mikrodialyse, Elektrokortikographie (ECoG)] ein verlässliches Bild.

Abstract

Posttraumatic increase of intracranial pressure (ICP) is a strong prognostic factor for the outcome of patients after traumatic brain injury. After exhausting all compensatory mechanisms ICP increases exponentially, where ICPnorm=(CSF production*CSF flow resistance)+venous pressure(sinus sagittalis)=10–15 mmHg. The ICP curve is influenced by the compliance (ΔV/ΔP) and elasticity (ΔP/ΔV) of the brain. Marmarou could demonstrate that the non-linear cranio-spinal pressure-volume relationship describes a logarithmic, mono-exponential, strongly linear relationship between pressure and volume and named this the pressure volume index (PVI=log ICP/ΔV). The pressure volume index describes the volume necessary to increase ICP by a factor of 10. Additionally to PVI the measurement of volume-pressure response (VPR) was introduced. The continuous intracranial compliance could be determined on the principle of pulsatile volume increases as an equivalent of very small intra-cranial volume increases. However, to ascertain functional status of the injured brain a combination of measurements of different parameters, such as tissue oxygen partial pressure (ptiO2), cerebral blood flow (CBF), microdialysis and electrocorticography (ECoG) is recommended.

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  1. Neurochirurgische Klinik, Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland

    K. Zweckberger, O.W. Sakowitz, A.W. Unterberg & K.L. Kiening

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  1. K. Zweckberger
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  2. O.W. Sakowitz
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  3. A.W. Unterberg
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  4. K.L. Kiening
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Correspondence to K. Zweckberger.

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Zweckberger, K., Sakowitz, O., Unterberg, A. et al. Intrakranielle Druck-Volumen-Beziehung. Anaesthesist 58, 392–397 (2009). https://doi.org/10.1007/s00101-009-1522-3

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