A Study On The Effection Of Barbiturates Coma Therapy On Intracranial Pressure And Cerebral Blood Flow Levels After Severe Traumatic Brain Injury In Humans

[Background]Traumatic brain injury is a very commom disease of neurosurgery.Especially,the severe traumatic brain injury(sTBI)has a very high mortality and morbidity,which is very a severe threaten to human health,so that is a important issue and difficult to be resolved in the field of neurosurgery.There were about 10-15%patients who suffered with a dangerous condition owing to the refractory Increased ICP,which uncontrolled of medicine or surgical operation,the mortality was about 84%to 100%.Since 1980s,the therapy of barbiturates coma had been used to controlled the refractory Increased ICP in sTBI.A large dose of barbiturates drug may decrease the level of ICP via declining the cerebral metabolic usage of oxygen and CBF,protect the partial or all the brain tissues.[Objective]In order to research on the effection of barbiturates coma therapy on the level intracranial pressure(ICP),cerebral blood flow(CBF),and relationship with the prognosis,and therapy mechanism after severe traumatic brain injury in humans.[Methods]102 patiens with sTBI(GCS≤8,ICP≥25mmHg)were divided randomly into 52 barbiturates coma therapy groups(BT,groups)and 50 convention therapy groups(CT,groups)in this experiment.All of patients had been performed multi-parameters monitoring,including cardiac monitoring,ICP monitoring,CBF monitoring,and barbiturates monitoring in BT group,compared with the alteration of ICP and CBF between two groups on five different time point including pre-therapy,6,24 and 48 hours post-therapy and 48 hour post-termination,and analyzed the correlation among clinical parameters GCS and GOS,approached the clinical outcome and therapeutic mechanism of barbiturates coma therapy on patients with sTBI.[Results]As a result:(1)The level of ICP began to decrease from 6 hour after barbiturate coma therapy,significantly descended from 24-48 hour and get to the lowest point,and sustained until 48 hour after termination.However,the CT groups' ICP are still in the high level all the time.The levels of CBF in BT group were significant lower than those of the levels in CT group on the same time,indicated that the barbiturates coma therapy may decrease the intracranial hypertension via declining the cerebral metabolic usage of oxygen and CBF.(2)The patients in BT group had occurred frequently the hypotension,must be controlled by pressor agent,and remained the adequate CPP.(3)The effective dose of barbiturates in plasma was about 2.24±0.61mg%,was lower than those of concentration in the foreign similar research.(4)Comparision with CT group,the mortality has a very significant declination(25.0%:38.0%)in BT group,but there was no any difference in the average GOS[(4.2±0.9):(3.8±0.4)]between two groups.[Conclusion]The treatment of the barbiturates coma can significantly decrease the refractory increased ICP via declining the cerebral metabolic usage of oxygen and CBF,raise the CPP,improve the condition of cerebral ischemia and hypoxia,protect brain tissues,however no obviously improvement in the clinical prognosis,is a important clinical second-tier Intervention.