Study on age-related normal intracranial pressure and cerebral perfusion pressure thresholds in children

Xiaobing CHEN; Wenyuan JI; Ping LIANG; Xuan ZHAI; Jianjun ZHOU; Yang CHENG; Xueling ZHAO

doi:10.16016/j.2097-0927.202306007

您当前的位置：

首页 >

文章列表页 >

Study on age-related normal intracranial pressure and cerebral perfusion pressure thresholds in children

Neuroscience | 更新时间：2026-01-09

- Study on age-related normal intracranial pressure and cerebral perfusion pressure thresholds in children
- Journal of Army Medical University Vol. 45, Issue 21, Pages: 2260-2265(2023)
- 作者机构：
  
  400014 重庆，重庆医科大学附属儿童医院神经外科，儿童发育疾病研究教育部重点实验室，国家儿童健康与疾病临床医学研究中心，儿童发育重大疾病国家国际科技合作基地，儿科学重庆市重点实验室
- 作者简介：
- 基金信息：
  
  Chongqing Medical Scientific Research Project（Joint Project of Chongqing Health Commission and Science and Teachnology Bureau）(2021MSXM014)
- DOI：10.16016/j.2097-0927.202306007
  CLC： R181.32;R443.5;R726.511
- Received：03 June 2023，
  
  Revised：2023-06-10，
  
  Published：15 November 2023
- 稿件说明：
移动端阅览
Xiaobing CHEN, Wenyuan JI, Ping LIANG, et al. Study on age-related normal intracranial pressure and cerebral perfusion pressure thresholds in children[J]. Journal of Army Medical University, 2023, 45(21): 2260-2265.
DOI：

Xiaobing CHEN, Wenyuan JI, Ping LIANG, et al. Study on age-related normal intracranial pressure and cerebral perfusion pressure thresholds in children[J]. Journal of Army Medical University, 2023, 45(21): 2260-2265. DOI： 10.16016/j.2097-0927.202306007.

摘要

目的

研究不同年龄段儿童颅内压及脑灌注压相对正常参考值。

方法

回顾性分析2015年1月至2022年6月重庆医科大学附属儿童医院神经外科收治的单纯硬膜外血肿行血肿清除及颅内压监测植入患儿

术后每小时监测患儿颅内压和动脉血压

分析不同年龄组的颅内压及脑灌注压随时间、年龄的变化特点

以术后稳定期(手术72 h后)颅内压及脑灌注压值作为儿童相对正常参考值

采用百分位数法分别统计计算颅内压及脑灌注压95%范围作为参考值范围。

结果

共纳入患儿207例

其中 < 2岁组25例

2~6岁组82例

>6岁组100例。术后不同年龄组颅内压均经历短暂较低水平后迅速升高

而脑灌注压均经历短暂的较高水平

并且两者在术后12~24 h达到高峰和低谷

于术后72 h逐渐达到稳定范围。手术72 h后颅内压范围: < 2岁为3.0~8.0 mmHg

2~6岁为5.0~11.0 mmHg

>6岁为6.0~14.0 mmHg; 脑灌注压范围: < 2岁50.9~68.7 mmHg

2~6岁55.0~73.3 mmHg

>6岁57.3~79.6 mmHg。

结论

不同年龄段儿童颅内压和脑灌注压相对正常参考值范围应有所不同

建议随年龄增加而增加。

Abstract

Objective

To study the normal reference values of intracranial pressure and cerebral perfusion pressure in children of different ages.

Methods

A retrospective study was conducted on the children with simple epidural hematoma who received hematoma removal and implantation for intracranial pressure monitoring in our department from January 2015 to June 2022.The intracranial pressure and arterial blood pressure of the children were monitored per hour after surgery

and the changes in intracranial pressure and cerebral perfusion pressure were analyzed based on time and age in different age groups.The intracranial pressure and cerebral perfusion pressure in stable period (72 h after surgery) were used as the relative normal reference values

and the 95% range of intracranial pressure and cerebral perfusion pressure were calculated statistically by percentile method as the reference range.

Results

A total of 207 children were included in this study

including 25 in the < 2-year-old group

82 in the 2~6-year-old group and 100 in the >6-year-old group.Intracranial pressure in different age groups was increased rapidly after a short period of low level

while cerebral perfusion pressure experienced a short period of high level

and both reached a peak and a trough from 12 to 24 h after surgery

and gradually reached a stable range at 72 h after surgery.The range of intracranial pressure 72 h after surgery was 3.0~8.0 mmHg for the < 2-year-old group

5.0~11.0 mmHg for the 2~6-year-old group

and 6.0~14.0 mmHg for the >6-year-old group.Cerebral perfusion pressure range was 50.9~68.7

55.0~73.3

and 57.3~79.6 mmHg

respectively for the above 3 age groups.

Conclusion

The normal ranges of intracranial pressure and cerebral perfusion pressure are different in children of different ages

and we suggest increasing with age.

关键词

Keywords

references

PADAYACHY L C, FIGAJI A A, BULLOCK M R. Intracranial pressure monitoring for traumatic brain injury in the modern era[J]. Childs Nerv Syst, 2010, 26(4): 441-452. DOI: 10.1007/s00381-009-1034-0.

APPAVU B, FOLDES S T, ADELSON P D. Clinical trials for pediatric traumatic brain injury: definition of insanity?[J]. J Neurosurg Pediatr, 2019, 23(6): 661-669. DOI: 10.3171/2019.2.PEDS18384.

中国医师协会神经外科医师分会, 中国神经创伤专家委员会. 中国颅脑创伤外科手术指南[J]. 中华神经创伤外科电子杂志, 2015, 1(1): 59-60. DOI: 10.3877/cma.j.issn.2095-9141.2015.01.018.

Neurosurgeons Branch of Chinese Medical Doctor Association, China Neurotrauma Expert Committee. China guidelines for traumatic brain injury surgery[J]. Chin J Neurotrauma Surg Electronic Ed, 2015, 1(1): 59-60. DOI: 10.3877/cma.j.issn.2095-9141.2015.01.018.

中国医师协会神经外科医师分会, 中国神经创伤专家委员会. 中国颅脑创伤颅内压监测专家共识[J]. 中华神经外科杂志, 2011, 27 (10): 1073-1074. DOI: 10.3760/cma.j.issn.1001-2346.2011.10.033.

Neurosurgeons Branch of Chinese Medical Doctor Association, China Neurotrauma Expert Committee. Expert consensus of intracranial pressure monitoring for traumatic brain injury in China[J]. Chin J Neurosurg, 2011, 27(10): 1073-1074. DOI: 10.3760/cma.j.issn.1001-2346.2011.10.033.

KOCHANEK P M, TASKER R C, CARNEY N, et al . Guidelines for the management of pediatric severe traumatic brain injury, Third edition: update of the Brain Trauma Foundation Guidelines, executive summary[J ] . Pediatr Crit Care Med, 2019, 20(3): 280-289. DOI: 10.1097/PCC.0000000000001736.

DONNELLY J, CZOSNYKA M, ADAMS H, et al . Twenty-five years of intracranial pressure monitoring after severe traumatic brain injury: a retrospective, single-center analysis[J ] . Neurosurgery, 2019, 85(1): E75-E82. DOI: 10.1093/neuros/nyy468.

HELMY A, VIZCAYCHIPI M, GUPTA A K. Traumatic brain injury: intensive care management[J]. Br J Anaesth, 2007, 99(1): 32-42. DOI: 10.1093/bja/aem139.

GUERRA S D, CARVALHO L F A, AFFONSECA C A, et al . Factors associated with intracranial hypertension in children and teenagers who suffered severe head injuries[J ] . J Pediatr (Rio J), 2010, 86(1): 73-79. DOI: 10.2223/jped.1960.

SIGURTÀ A, ZANABONI C, CANAVESI K, et al . Intensive care for pediatric traumatic brain injury[J ] . Intensive Care Med, 2013, 39(1): 129-136. DOI: 10.1007/s00134-012-2748-0.

谭泽梁, 杨志勇, 蔡成柱, 等. 国内脑出血颅内压监测值参考标准的初步探索[J]. 中国实用神经疾病杂志, 2017, 20(14): 29-33. DOI: 10.3969/j.issn.1673-5110.2017.14.009.

TAN Z L, YANG Z Y, CAI C Z, et al . Tentative exploration of domestic reference standards of intracranial pressure in patients with intracerebral hemorrhage[J ] . Chin J Pract Nerv Dis, 2017, 20(14): 29-33. DOI: 10.3969/j.issn.1673-5110.2017.14.009.

张雷, 梁平, 翟瑄, 等. 儿童颅脑创伤后颅内压及脑灌注压的临床特点[J]. 中华创伤杂志, 2014, 30(10): 995-999. DOI: 10.3760/cma.j.issn.1001-8050.2014.10.007.

ZHANG L, LIANG P, ZHAI X, et al . Clinical features of intracranial pressure and cerebral perfusion pressure after craniocerebral trauma in children[J ] . Chin J Trauma, 2014, 30(10): 995-999. DOI: 10.3760/cma.j.issn.1001-8050.2014.10.007.

陈小兵, 张雷, 赵雪灵, 等. 儿童重型创伤性脑损伤的颅内压及脑灌注压治疗阈值研究[J]. 第三军医大学学报, 2020, 42(22): 2167-2175. DOI: 10.16016/j.1000-5404.202007043.

CHEN X B, ZHANG L, ZHAO X L, et al . Intervention thresholds of intracranial pressure and cerebral perfusion pressure in children with severe traumatic brain injury[J ] . J Third Mil Med Univ, 2020, 42(22): 2167-2175. DOI: 10.16016/j.1000-5404.202007043.

PEDERSEN S H, LILJA-CYRON A, ASTRAND R, et al . Monitoring and measurement of intracranial pressure in pediatric head trauma[J ] . Front Neurol, 2020, 10: 1376. DOI: 10.3389/fneur.2019.01376.

BASAMH M, ROBERT A, LAMOUREUX J, et al . Epidural hematoma treated conservatively: when to expect the worst[J ] . Can J Neurol Sci, 2016, 43(1): 74-81. DOI: 10.1017/cjn.2015.232.

赵玉沛, 陈孝平, 杨连粤, 等. 外科学[M]. 3版. 北京: 人民卫生出版社, 2015: 256.

ZHAO Y P, CHEN X P, YANG L Y, et al . Surgery[M ] . 3rd ed. Beijing: People's Medical Publishing House, 2015: 256.

PEDERSEN S, J∅RGENSEN A, ANDRESEN M, et al . Differences in intracranial pressure seen in children and adults could be caused by age differences[J ] . Fluids Barriers CNS, 2015, 12(suppl 1): O21. DOI: 10.1186/2045-8118-12-s1-o21.

LOVETT M E, O'BRIEN N F, LEONARD J R. Children with severe traumatic brain injury, intracranial pressure, cerebral perfusion pressure, what does it mean? A review of the literature[J]. Pediatr Neurol, 2019, 94: 3-20. DOI: 10.1016/j.pediatrneurol.2018.12.003.

DUNN L T. Raised intracranial pressure[J]. J Neurol Neurosurg Psychiatry, 2002, 73(Suppl 1) : i23-i27. DOI: 10.1016/S0140-6736(73)92724-4.

CARNEY N, TOTTEN A M, O'REILLY C, et al . Guidelines for the management of severe traumatic brain injury, fourth edition[J ] . Neurosurgery, 2017, 80(1): 6-15. DOI: 10.1227/NEU.0000000000001432.

WIEGAND C, RICHARDS P. Measurement of intracranial pressure in children: a critical review of current methods[J]. Dev Med Child Neurol, 2007, 49(12): 935-941. DOI: 10.1111/j.1469-8749.2007.00935.x.

MOUNT C A, DAS J M. Cerebral perfusion pressure[M]. Treasure Island: StatPearls Publishing, 2023.

CHAMBERS I R. Critical thresholds of intracranial pressure and cerebral perfusion pressure related to age in paediatric head injury[J]. J Neurol Neurosurg Psychiatry, 2006, 77(2): 234-240. DOI: 10.1136/jnnp.2005.072215.

ALLEN B B, CHIU Y L, GERBER L M, et al . Age-specific cerebral perfusion pressure thresholds and survival in children and adolescents with severe traumatic brain injury[J ] . Pediatr Crit Care Med, 2014, 15(1): 62-70. DOI: 10.1097/PCC.0b013e3182a556ea.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Intervention thresholds of intracranial pressure and cerebral perfusion pressure in children with severe traumatic brain injury

Intracranial pressure monitoring guides the dose of propofol in anesthesia for craniocerebral trauma patients

Perioperative monitoring of intracranial pressure in 29 children with hydrocephalus and its clinical significance

Safe and effective concentration of ropivacaine in interscalene brachial plexus block for children aged 6 to 10 years: a sequential allocation study

Related Author

Xiaobing CHEN

Lei ZHANG

Xueling ZHAO

Ping LIANG

Xuan ZHAI

Lusheng LI

Yudong ZHOU

Jianjun ZHOU

Related Institution

Department of Neurosugery, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Child Development and Disorders of Ministry of Education, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University

Department of Neurology and Neurosurgery, the Third Affiliated Hospital of Chongqing Medical University

Department of Neurosugery，National Clinical Research Center for Child Health and Disorders ，Key Laboratory of Child Development and Disorders of Ministry of Education ，Chongqing Key Laboratory of Pediatrics ，Children’s Hospital of Chongqing Medical University

Department of Anesthesiology, Southwest Hospital, Third Military Medical University

Department of Anesthesiology, Jilin Provincial Hospital of Traditional Chinese and Western Medicine

⁰