Intensive therapy of cerebral edema
І. Etiopathogenetic: elimination of the cause of the emergence of pathology; treatment of the underlying disease; normalization of gas exchange; stabilization of hemodynamics; correction of KLS, water-electrolyte shifts, metabolic processes; detoxification; antiallergic therapy; immunocorrection.
ІІ. Local therapy of cerebral edema: normalization of cerebral hemodynamics, in particular microcirculation, rheological properties of blood; stabilization of cell membranes, reduction of vascular permeability; inactivation of proteolytic enzymes, vasoactive substances, free radical oxidation; normalization of brain metabolism; hormonal therapy; normalization of intracranial volumes and correction of water-electrolyte metabolism disorders (adequate infusion therapy, dehydration, extracorporeal correction of water-electrolyte metabolism disorders), use of calcium channel blockers; hypothermia.
III. Symptomatic: elimination of seizures; correction of temperature homeostasis; preventive antibacterial therapy; correction of violations of internal organs; adequate nutrition; intensive supervision and care.
Normalization of gas exchange is ensured by maintaining free airway passages, oxygen therapy, IVL, which is performed in the regime of abstinent hyperventilation with RASO2 4-4,4 kpa (30-33 mm Hg). It reduces the blood filling of the brain and improves blood circulation, in ischemic zones, preventing further buildup of cerebral edema. Continuation of mechanical ventilation in the background of vasoconstriction changes the metabolism of the brain and does not affect the development of edema. It is particularly advisable to use ALV in the first 24 hours after the onset of cerebral edema.
The use of HBO is contraindicated in connection with the danger of the development of oxygen intoxication and increased edema-swelling of the brain.
Stabilization of hemodynamics is aimed atnormalization of BCC, systemic AD, prevention of hypo- and hypertension, and improvement of microcirculation (maintain a hematocrit at 0.30-0.35 g / l), rheological properties of blood. With gipertenzii can be used ganglioblokatori (simultaneously reduce the permeability of the BBB).
1. Normalization of cerebral hemodynamics is provided by improving microcirculation,rheological properties of blood, vascular tone. It should be remembered that the rapid restoration of the blood circulation of the brain is the cause of the development of significant ischemic damage to the structures of the brain tissue. To normalize cerebral hemodynamics use: trental-5 ml (100 mg) 2% solution, it is better to inject intravenously drip. Normalizes the z-potential of cells, enhances the glycolytic process, reduces potassium loss by cells, does not predetermine the occurrence of "stigmatization syndrome." Children - 1-3 mg / (kg-day).
Currantyl (dipyridamole) - does not affecthemodynamics, does not cause hemorrhagic complications, the syndrome of "robbery". Ingenious kininy. Apply 2 ml (10 mg) of a 0.5% solution. For children 0.2-0.5 mg / kg. Complamine (theonikol, xanthinol nicotinate) - 2 ml (300 mg) of 15% solution fractionally or drip. Drugs of nicotinic acid can worsen venous outflow, especially with rapid administration. Cavinton - eliminates arterial angiospasm, raises the level of endurance to hypoxia, acts as an antiaggregant. It is not applied in case of threat of development of hemorrhage. Selectively enhances cerebral circulation. Do not use with heparinine! Assign a dose of 25-30 mg / kg, for children - for0.25-0.5 mg / (kg-day) 0.5% solution. Eufilin - increases the need for tissues in oxygen, without changing the level of oxidative phosphorylation. Promotes vasoconstriction of cerebral vessels, can cause the emergence of a "robbery syndrome"When using a brain edema, use with caution. Dose - 6-20 mg / (kg-day), used as a 2.4% solution, for children under 1 year, the same solution is administered at a rate of 1 mg / (kg-day), children age 2-4 years - 4 mg / (kg-day).
The venous outflow of blood is assisted by the position of the patient on the back with the upper half of the trunk raised. Turning the head to the side, throwing it back increases the VTPD.
Sermion (nicergoline) - except for improvementmicrocirculation, reduces permeability and fragility of capillaries. Children are administered 6-10 mg / (kg-day) of 10% solution. Analogous for the action of sulfocamphocaine - 6-25 mg / (kg-day). L-lysine succinate 0.1% intravenously 5.0 ml. Low molecular weight dextran (rheopolyglucin) after stabilization of cellular andvascular membranes, with hypervolemia, their use is contraindicated. They facilitate the movement of fluid into the intercellular space into the vascular bed, which improves microcirculation. Danger of increased cerebral edema. Children are administered 10 ml / (kg-day.) At a rate of 0.15-0, 2 ml / (kg-min). Dopamine is used at a rate of 2-5 μg / (kg-min) for vasodilation of cerebral vessels.