脳死とＮｅｕｒｏｓｏｎｏｌｏｇｙ　　頭蓋内圧とＴＣＤによる頭蓋内血流動態の検討

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  • Evaluation of Intracranial Hemodynamics Using ICP and TCD

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CPP (cerebral perfusion pressure) is the major factor determining the pressure flow characteristics in the cerebral vascular bed. Aaslid proposed that the CPP index could be estimated by combining information about arterial blood pressure and the Doppler flow velocity waveform of the intracranial arteries. The characteristics of pressure wave transmission in the intracranial cavity were determined by coherency. Sixteen cats were used to measure the ICP increase induced by hydrostatic pressure loading. BP and ICP were monitored using a Camino Digital Pressure Monitor 420 by catheterization into the abdominal aorta through the femoral artery and by Rt-fronter subarachnoid space catheterization, respectively. The intracranial blood flow Doppler signals were measured transorbitally using MF-20. The CPP index decreased as the ICP increased, indicating a correlation between CPP (BP-ICP) and CPP index. The slope of the straight line determined by coherency was greater between 45 and 70 mmHg than between 10 and 45 mmHg. This suggests that there is a point, located between 45 and 70 mmHg, where the increase in coherency values is accelerated. This is caused by the increase in intracranial elastance, as well as the increase in cerebrovascular compliance due to the reduced vascular transmural pressure.

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