頭部外傷腦內壓升高
關於硬膜上出血和下出血
車禍等意外容易造成硬膜上出血，主要原因是動脈破裂，通常是中腦膜動脈的分支破裂。當頭部受到撞擊時，顱骨內板的銳利邊緣割傷通過的動脈，導致動脈血在硬腦膜和顱骨內板之間積聚，形成血腫。
Traumatic brain injuries such as car accidents often result in epidural hematomas, primarily caused by arterial bleeding, typically from a branch of the middle meningeal artery. When the head is struck, the sharp edge of the inner table of the skull lacerates the passing artery, causing arterial blood to accumulate between the dura mater and the inner table of the skull, forming a hematoma.
靜脈血管破裂通常導致硬膜下出血，而非硬膜上出血。硬膜下出血的出血速度較慢，臨床表現也與硬膜上出血不同。
Venous bleeding usually leads to subdural hematomas, not epidural hematomas. Subdural hematomas develop more slowly and have different clinical presentations compared to epidural hematomas.
硬膜上出血常有一個潛伏期，患者在受傷後可能有一段時間的清醒，隨後因血腫逐漸擴大，顱內壓升高而導致意識改變，常見症狀包括頭痛、嘔吐、意識模糊、瞳孔大小不等等，硬膜上出血通常需要手術治療，手術的目的在於清除血腫，減輕顱內壓，防止腦組織受損。
Epidural hematomas often have a latent period. Patients may be lucid for a period of time after the injury, followed by a decline in consciousness as the hematoma gradually expands and intracranial pressure increases. Common symptoms include headache, vomiting, altered mental status, and unequal pupil size. Epidural hematomas typically require surgical intervention to remove the hematoma, reduce intracranial pressure, and prevent brain damage.
常見的頭部外傷檢查
Common diagnostic tests for head injuries:
電腦斷層掃描（CT）： 是診斷硬膜上出血最常用的方法，可以快速、準確地顯示顱內出血的情況。
Computed tomography (CT) scan: This is the most common imaging method for diagnosing epidural hematomas. It can quickly and accurately visualize intracranial bleeding.
顱內壓升高代償
當顱內出血導致顱內壓升高時，身體會啟動一系列的代償機制，試圖維持顱內環境的穩定。
When intracranial hemorrhage causes an increase in intracranial pressure (ICP), the body initiates a series of compensatory mechanisms to try to maintain the stability of the intracranial environment.
1.當顱內壓升高時，身體會增加腦脊髓液CSF的吸收，以減少顱內液體的總量，降低顱內壓。
Increased absorption of cerebrospinal fluid (CSF): As ICP rises, the body increases the absorption of CSF to reduce the total volume of intracranial fluid and thus lower ICP.
2.腦血管收縮，減少血流進入腦部，以降低顱內血容量。
Cerebral vasoconstriction: Blood vessels in the brain constrict to reduce blood flow into the brain, thereby decreasing intracranial blood volume.
3.硬腦膜向外膨出，提供額外的空間容納增加的顱內內容物。
Dural bulging: The dura mater bulges outward to provide additional space to accommodate the increased intracranial contents.
然而，這些代償機制只能在一定程度上緩解顱內壓。
However, these compensatory mechanisms can only alleviate the increased ICP to a certain extent.
當顱內壓持續升高且超過了身體的代償能力時，就會出現嚴重的併發症，如腦疝、意識障礙、呼吸衰竭等
When ICP continues to rise and exceeds the body's compensatory capacity, severe complications such as herniation, altered consciousness, and respiratory failure can occur.
治療顱內壓升高
Mannitol 是一種滲透性利尿劑，可透過增加血漿滲透壓來引流腦脊髓液，從而降低顱內壓。
Mannitol is an osmotic diuretic that can reduce intracranial pressure (ICP) by drawing cerebrospinal fluid (CSF) into the bloodstream through increasing plasma osmolality.
Mannitol 通常用於治療頭部外傷、腦出血、腦梗塞等導致顱內壓升高的疾病。
Mannitol is commonly used to treat diseases that cause elevated ICP, such as head trauma, cerebral hemorrhage, and cerebral infarction.
Mannitol 的作用機制是增加血漿滲透壓，使水分從腦組織流向血漿，從而減少腦組織的水分含量和體積，降低顱內壓。
The mechanism of action of mannitol is to increase plasma osmolality, causing water to flow from brain tissue into the plasma, thereby reducing brain water content and volume, and lowering ICP.
然而，Mannitol 也可以導致脫水和電解質紊亂，因此在使用 Mannitol 降腦壓時，應注意以下事項：
However, mannitol can also lead to dehydration and electrolyte disturbances. Therefore, the following should be noted when using mannitol to reduce ICP:
監測病人的尿量、體重、血壓、血尿素氮、肌酐等指標，及時糾正脫水和電解質紊亂。
Monitor the patient's urine output, weight, blood pressure, blood urea nitrogen, creatinine, and other indicators, and promptly correct dehydration and electrolyte disturbances.
監測病人的血糖，因為 Mannitol 可以導致血糖升高，研究表明，Mannitol 可導致血糖升高 10-20 mg/dL。在糖尿病患者或有高血糖風險的患者中，Mannitol 導致血糖升高的風險更高。
Monitor the patient's blood sugar, as mannitol can cause hyperglycemia. Studies have shown that mannitol can cause an increase in blood sugar of 10-20 mg/dL. Patients with diabetes or at risk of hyperglycemia are at higher risk of hyperglycemia from mannitol.
但其實Mannitol本身不會影響血糖。Mannitol是一種滲透利尿劑，其作用機制是通過增加血漿滲透壓來脫水，從而減少顱內壓。Mannitol不會影響胰島素的分泌或糖的代謝，因此不會導致血糖的變化，不過應注意血糖的變化。
In fact, mannitol itself does not affect blood sugar. Mannitol is an osmotic diuretic that works by increasing plasma osmolality to dehydrate and reduce intracranial pressure (ICP). Mannitol does not affect insulin secretion or glucose metabolism, and therefore does not cause changes in blood sugar levels. However, it is important to monitor blood sugar levels.
另外頭部外傷病人顱內壓升高的處置，除了可利用Mannitol藥物降壓，還有：
In addition to the use of mannitol to reduce ICP in patients with head trauma, other treatments include:
急性期可裝置顱內壓監測器，評估顱內壓升高程度和治療效果，依醫囑引流腦脊髓液降低顱內壓。
Intracranial pressure monitoring can be performed in the acute phase to assess the severity of ICP elevation and the effectiveness of treatment. CSF drainage can be performed as ordered by a physician to reduce ICP.
且使用格拉斯哥昏迷量表（GCS）是一種用於評估意識水平的工具。GCS 滿分為 15 分，總分為 5 分表示病人處於昏迷狀態。
The Glasgow Coma Scale (GCS) is a tool used to assess the level of consciousness. The GCS has a maximum score of 15 points, and a total score of 5 points indicates that the patient is in a coma.
且須注意若病人的瞳孔突然放大、對光沒有反應或是固定、肌力及意識下降，有可能是顱內壓升高。
It should also be noted that if the patient's pupils are suddenly dilated, unresponsive to light or fixed, and there is a decrease in muscle strength and consciousness, this may be a sign of elevated ICP.
留言