— 生理適應 · MEDIUM · MCQ —
一位嚴重頭部外傷的病人正在接受顱內壓（ICP）監測。何項發現表示需要立即干預？
A client with a severe head injury is being monitored for increased intracranial pressure (ICP). Which finding indicates a need for immediate intervention?
- APupils are equal and reactive to light瞳孔等大且對光反應正常
- BLethargy progressing to stupor✓ 正解嗜睡進展至昏睡
- CICP reading of 18 mmHg顱內壓 (ICP) 讀數為 18 mmHg
- DCerebral perfusion pressure (CPP) of 50 mmHg腦灌流壓 (CPP) 為 50 mmHg
— Explanation · 中文詳解 —
意識狀態的惡化（從昏睡到遲鈍）是顱內壓升高的警訊，表示腦部灌流和功能受到嚴重影響，需要立即處理。ICP 18 mmHg 雖偏高，但 CPP 50 mmHg 才是警訊，因為 CPP <60 mmHg 可能導致腦部灌流不足。瞳孔正常代表腦幹功能穩定。
A change in level of consciousness from lethargy to stupor indicates deteriorating brain function and critically increased intracranial pressure requiring immediate intervention. Although a cerebral perfusion pressure of 50 mmHg is low, the progressive neurological decline is the most urgent clinical sign of worsening status.
✦ 台美臨床差異
美國神經外科團隊在監測 ICP 時，會同時密切觀察 CPP；台灣亦同，但可能因生理監視儀器的普及程度而有差異。