臺灣博碩士論文加值系統

頭部外傷是一重大傷害，嚴重者甚至會造成昏迷或死亡。當頭部外傷病患一旦顱內壓增高，就必需要接受減壓開顱手術，為避免手術後病患情緒影響腦壓，術後會使用數天的鎮定劑，以控制腦壓變化；然而手術麻醉和鎮靜作用則容易導致肺泡塌陷。在頭部外傷手術後的病患中，約有80%會發生肺部合併症，因此，照顧此類病患不僅保護神經功能，也需要顧及其肺部安全。本研究採描述性相關研究設計，連續系列的1042名頭部外傷病患進行回顧性分析，探討呼氣末期正壓對腦壓及相關因素之影響，收集內容包含基本資料與生理檢測，自西元2006年6月1日至西元2012年5月31日止。研究結果顯示：(1)性別與入院APACHE II score、手術後三天內GCS值呈顯著差異(P<0.05)。(2)抽菸與入院APACHE II score、手術後三天內之ICP值、GCS值呈顯著差異(P<0.05)。(3)病患後續發展與入院APACHE II score、手術後三天內之ICP值、GCS值呈顯著差異(P<0.05)。(4)PEEP值設定(0-5、6-10和11-15 cmH2O)不影響手術後三天內之ICP、GCS值(P＞0.05)；但PEEP值與手術後第一天CPP、手術後三天內之HR皆呈顯著差異(P<0.05)。(5)手術後三天期間，ICP先上升後略微降低、CPP呈逐日遞減至穩定、GCS逐日增加，且APACHE II score、GCS皆與ICP呈顯著相關(P<0.001)。本研究結果能提供臨床人員照顧腦部外傷病患手術後之相關醫療知識，期望在照護此類病患過程中有所助益。

Head injury is a major problem. It may even cause coma or death. When the intracranial pressure increased, the patient with head injury should be accepted the decompressive craniectomy. For preventing the emotion of patient after operation from influencing intracranial pressure (ICP), they will receive tranquilizers for several days to control the ICP changes. However, the anesthesia and tranquilization easily lead to alveolar collapse. Pulmonary complications will occur to 80% or so patients after surgery. Therefore, such patients’ care will be forcused on protecting not only the nerve function, but also the lung safety. The research was designed to be descriptive correlation. A consecutive series of 1042 patients with head injury were retrospectively reviewed to explore the effect of using positive end-expiratory pressure (PEEP) on ICP and related factor. The contents collected included basic data and physiological values from June 1 in 2006 to May 31 in 2012. The results were shown that (1)there were significant differences between gender and APACHE II score at admission or GCS within 3 days after surgery(P<0.05). (2)There were significant differences between smoking and APACHE II score at admission or ICP within 3 days after surgery or GCS within 3 days after surgery (P<0.05). (3)There were significant differences between patient follow-up development and APACHE II score at admission or ICP within 3 days after surgery or GCS within 3 days after surgery (P<0.05). (4)The PEEP set up from 0 to 5, to 6 to 10 and 11 to 15 did not affect ICP and GCS within 3 days after surgery (P＞0.05). But, the differences between PEEP and CCP at 1st day after surgery or heart rates (HR) within 3 days after surgery were proved (P<0.05). (5)During the 3 days after surgery, ICP initially increased and then decreased a little. A day-by-day decrease of CPP became stable and GCS increased daily. Furthermore, both APACHE II score and GCS were significantly related with ICP (P<0.001). The study results can supply the related medical knowledges for clinical staffs to take care of patients with head injury after surgery, and expect to be helpful in the process of such kind of patient care.

中文摘要 I
英文摘要 III
目錄 V
表目錄 VIII
圖目錄 IX
第一章 緒論
第一節 研究背景與研究動機 1
第二節 研究重要性 2
第三節 研究目的 3
第四節 研究問題 4
第五節 名詞界定 4
第二章 文獻查證
第一節 頭部外傷 6
第二節 頭部外傷與肺損傷之關係 8
第三節 頭部外傷與呼吸器使用的相關研究 10
第三章 研究方法
第一節 研究設計 13
第二節 研究場所與研究對象 14
第三節 研究架構 15
第四節 樣本數估計 16
第五節 研究工具 16
第六節 資料分析 17
第七節 研究對象倫理考量 18
第四章 結果
第一節 基本資料 20
第二節 基本資料與ICP、CPP和相關影響因素之比較 20
第三節 手術後三天內PEEP值設定與ICP、CPP相關影響因素之比較 21
第四節 ICP、CPP與相關影響因素在手術後三天內之變化 22
第五節 手術後三天內ICP、CPP與年齡、PEEP、影響因素之相關 24
第五章 討論
第一節 基本資料與GCS、APCHEII SCORE之關係 42
第二節 基本資料與ICP、CPP和相關影響因素(MAP、心跳等)之關係 46
第三節 手術後三天內PEEP值設定值與ICP、CPP、相關影響因素之關係 50
第四節 ICP、CPP與相關影響因素術後三天內之變化與相關性 51
第六章 結論 53
第七章 限制與建議
第一節 研究限制 55
第二節 臨床實務上的應用 55
第三節 未來研究建議 56
第四節 未來展望 57
參考文獻 58
中文部分 58
英文部分 59
附錄
表目錄
表一 研究對象之基本資料 26
表二 基本資料與手術後第一天GCS之比較 27
表三 基本資料與手術後三天內ICP之比較 28
表四 基本資料與手術後三天內CPP之比較 29
表五 基本資料與手術後三天內相關影響因素之比較 30
表六 手術後三天內PEEP值設定與ICP之比較 34
表七 手術後三天內PEEP值設定與CPP之比較 35
表八 手術後三天內PEEP值設定與相關影響因素之比較 36
表九 手術後三天內之ICP、CPP與相關影響因素之變化 40
表十 年齡、PEEP、影響因素與ICP、CPP之相關 41
圖目錄
圖3-1 研究架構圖 155

行政院衛生署(2011)．台灣地區主要死因．2011年5月10日取自於http://www.doh.gov.tw/statistic /index.htm〔Department of Health, Taiwan, ROC. (2011). The main causes of death in Taiwan.2011.05.10 Retrieved from http://www.doh.gov.tw/statistic /index.htm〕
江盛君、江玲玲、林乾閔、李俊年、蘇千玲(2008)．神經外科術後病患呼吸器策略之應用．台灣呼吸治療誌，7(2)，71-78。〔Chun, C. S., Chiang, L. L., Lin, C. M., Lee, C. N., & Su, C. L. (2008). Ventilator Strategy in Neurosurgery Patients. The journal of Respiratory Therapy ,7(2),71-78.〕doi:10.6200/TCMJ.2011.8.3. 09
邱豔芬(2000)‧從腦灌流與腦組織的存活談頭部外傷病人的護理‧謢理雜誌，47(3)，59-64。〔Chao, Y. F. (2000). Nursing Care of Head Injured Patients from the Perspective of Maintaining Cerebral Perfusion and Preservation of Brain Tissue. The Journal of taiwan Nursing,47(3),59-64.〕doi: 10.6224/JN.47.3.59
吳德敏、邱文達、洪慶章 (1991)．青少年頭部外傷之調查研究．醫學研究，12(2)，104-115。〔Wu, D. M., Chiu, W. T., & Hung, C.C. (1991). A Study OF Head Injury Among Teenagers. The Journal of Medicine scince, 12(2), 104-115〕doi:10.6141/TW-SRDA-E88117-1
林家瑋、蔡宛真、邱文達、林天仁、江培業、林乾閔…….蔡卓城 (2004)．台灣地區頭部外傷性顱內出血之研究．醫學研究，15(1)，20-28。〔Lin, J. W., Tsai, W. C., Chiu, W. T., Lin, T. J., Chiang, P. Y., Lin, C.M.……Choy, C. S. (2004). Survey of Intracranial Hematoma in Taiwan. Journal of Emergency and Critical Care Medicine,15(1),20-28〕doi:10.6141/TW-SRDA-E87098-1
陳寶貝、林碧華、 李俊德 (2011) ‧ 住院中低氧合病患使用侵襲性正壓呼吸器的成效 ‧呼吸治療，10(2)，1-11。〔Chen, P. P., Lin, P. H., & Lee, J. D. (2011). Outcome of in-Patient With Poor Oxygenation Using Invasive Positive Mechanical ventilator. The Journal of Taiwan Physical Therapy,10(2), 1-11.〕doi: 10.6200/TCMJ.2007.4.9.16
黃乃勤、張新(2005)‧實證醫學下之嚴重頭部外傷治療‧慈濟醫學，17(5)，1-6。〔Haung, N. C., & Chang, C. (2005). Severe head trauma treatment under the Evidence-Based Medicine. The Journal of Tzu Chi Mediation, 17(5), 1-6.〕doi: 10.6200/TCMJ.2006.3.11.06
賴建丞、白璐、蔡行瀚、簡戊鑑、張瑋庭、林佳欣、洪宇箴 (2009)‧神經外科事故傷害頭部重創患與家屬之需求分析‧北市醫學雜誌 , 6(3)，174 - 184。〔Lai, C. C., Pai, L., Tsai, S. H., Chien, W. C., Chang, W. T., Lin, C.H., Hung, Y. H. (2009). Accidents Neurosurgery Suffering Serious Head Injuries and Demand Analysis of the Family. Taipei City Medical Journal, 6(3), 174 - 184〕doi:10.6200/TSMJ.2009.6.3.02
Almeida,O. P., Garrido, G. J., Alfonso, H., Hulse, G., Lautenschlager, N. T., Hankey, G. J., & Flicker, L. (2011). 24-month effect of smoking cessation on cognitive function and brain structure in late lift. Neuroimage, 55(4), 1480-1490. doi :10.1016/j.neuroimage.2011.01.063
Amato, M. B., Barbas, C. S., Medeiros, D. M., Schettino, G. P., Lorenzi, F. G., Kairalla, R. A., . . . Takaqaki, T. Y., (1995). Beneficial effects of the "open lung approach" with low distending pressures in acute respiratory distress syndrome. A prospective randomized study on mechanical ventilation. Am J Respir Crit Care Med, 152(6 Pt 1), 1835-1846. doi: 10.1164/ajrccm.152.6.8520744.
Amato, M. B. P., Barbas, C. S. V., Medeiros, D. M., Magaldi, R. B., Schettino, G. De P. P., Lorenzi-Filho, G.,… Carvalho, C. R. R. (1998). Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med, 338(6), 347-354. doi: 10. 1056 / nejm 1998 02053380602
Brochard, L., Roudot-Thoraval, F., Roupie, E., Delclaux, C., Chastre, J., Fernandez-Mondejar, E., . . . Lemaire, F. (1998). Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. The Multicenter Trail Group on Tidal Volume reduction in ARDS. Am J Respir Crit Care Med, 158(6), 1831-1838. doi: 10.1164/ajrccm158.6.9801044
Chiu, W. T., Lin, T. J., Lin, J. W., Huang, S. J., Chang, C. K., & Chen, H. Y. (2006). Multicenter evaluation of propofol for head-injured patient in Taiwan. Surgical Neurology, 66, S2: 37-S2:42. doi: 10.1016/j.surneu.2006.08.028
Chibbaro, S., Tacconi, L., & Frcs. (2007). Role of decompressive craniectomy in the management of severe head injury with refractory cerebral edema and intractable intracranial pressure Our experience with 48 cases. Surgical Neurology, 67, 632-638.dio:10.1016/j.surneu.2006.12.046
Demetriades, D., Kuncir, E., Murray, J., Velmahos, G C., Rhee, P., & Chan, L. (2004). Mortality Prediction of Head Abbreviated Injury Score and Glasgow Coma Scale: Analysis of 7,764 Head Injuries. Jam Coll Surg, 199(2), 216-222. doi: 10.1016/j.jamcollsurg.2004.02.030
Doyle, R. L., Szaflarski, N., Modin, G. W., Wiener-Kronish, J. P., & Matthay, M. A. (1995). Identification of patients with acute lung injury. Predictors of mortality. Am J Respir Crit Care Med, 152(6 Pt 1), 1818-1824.
Domino, E F., Ni, L., Thompson, M., Zhang, H., Shikata, H., Fukai, H., Sakaki, T., & Ohya, I. (2009). Tobacco Smoking Produces Widespreas Dominant Brain Wave Alpha Frequency Increases. Int J Psychophysiol,74(3),192-
198. doi : 10.1016/j.ijpsycho.2009.08.011
Durazzo, T. C., Cardenas, V. A., Studholme, C., Weiner, M. W. & Meyerhoff, D. J. (2007). Non-treatment-seeking heavy drinkers: effects of chronic cigarette smoking on brain structure. Drug & Alcohol Dependence, 87(1), 76-82. doi: 10.1016/j.drugalcdep.2006.08.003
Eichacker, P. Q., Gerstenberger, E. P., Banks, S. M., Cui, X., & Natanson, C. (2002). Meta-analysis of acute lung injury and acute respiratory distress syndrome trials testing low tidal volumes. Am J Respir Crit Care Med, 166(11), 1510-1514. doi: 10.1164/rccm.200208-956OC
Fandino, J., Stocker, R., Prokop, S., Trentz, O., & Imhof, H. G. (2000). Cerebral Oxygenation and systemic trauma related factors determining neurological outcome after brain injury. Journal of Clinical Neuroscience, 7(3), 226-233. doi:10.1054/jocm.1999.0202
Forsyth, R. J., Wolny, S., & Rodrigues, B. (2010). Routine intracranial pressure monitoring in acute coma. The Cochrane collaboration Issue 12, 1-13. doi: 10.1005/14651858.CD002043
Gajic, O., Frutos-Vivar, F., Esteban, A., Hubmayr, R. D., & Anzueto, A. (2005). Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients. Intensive Care Med, 31(7), 922-926. doi: 10.1007/s00134-005-2625-1
Gallinat, J., Meisenzahl, E., Jacobsen, L K., Kalus, P., Bierbrauer, J., Kienast, T.,...Staedtgen, M. (2006). Smoking and structural brain deficits: a volumetric MR investigation. European Journal of Neuroscience, 24, 1744-1750. doi: 10.1111/j.1460-9568.2006.05050.x
Gattinoni, L., Pelosi, P., Suter, P. M., Pedoto, A., Vercesi, P., & Lissoni, A. (1998). Acute respiratory distress syndrome caused by pulmonary and extra-pulmonary disease. Different syndromes. Am J Respiration Critical Care Med, 158(1), 3-11. doi: 10.1164/ajrccm.158.1.9708031
Gattinoni, L., Caironi, P., Cressoni, M., Chiumello, D., Ranieri, V. M., Quintel, M., . . . Bugedo, G. (2006). Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med, 354(17), 1775-1786. doi: 10.1056/NEJMoa052052
Holland, M. C., Mackersie, R. C., Morabito, D., Campbell, A. R., Kivett, V. A., Patel, R., . . . Pittet, J. F. (2003). The development of acute lung injury is associated with worse neurologic outcome in patients with severe traumatic brain injury. The Journal of Trauma, 55(1), 106-111. doi: 10.1097/01.ta.0000071620.27375.be
Hong, W. C., Tu, Y. K., Chen, Y. S., Lien, L. M., & Huang, S. J. (2006). Subdural intracranial pressure monitoring in severe head injury: clinical experience with the Codman MicroSensor. Surgical Neurology, 66, S2:8-S2:13. doi:10.1016/j.surneu.2006.07.006
Huang, S. J., Hong, W. C., Han, Y. Y., Chen, Y. S., Wen, C. S., Tsai, Y. S., & Tu, Y. K. (2006). Clinical outcome of severe head injury using three different ICP and CPP protocol-driven therapies. Journal of Clinical Neuroscience, 13, 818-822. doi: 10.1016/j.jocn.2005.11.034
Hudson, L. D., Milberg, J. A., Anardi, D., & Maunder, R. J. (1995). Clinical risks for development of the acute respiratory distress syndrome. Am J Respir Crit Care Med, 151(2 Pt 1), 293-301. doi: 10.1164/ajrccm.151.2.7842182
Huynh, T., Messer, M., Sing, R. F., Miles, W., Jacobs, D. G., & Thomason, M. H. (2002). Positive end-expiratory pressure alters intracranial and cerebral perfusion pressure in severe traumatic brain injury. The Journal of Trauma, 53(3), 488-492; discussion 492-483. doi: 10.1097/01.ta.0000025657.37314.2f
Jain, S., Dharap, S B., Gore, M A. (2008). Early prediction of outcome in very severe closed head injury. International Journal of the inured, 39, 598-603. doi: 10.1016/j.imjury.2007.06.003
Kallet, R. H. (2004). Evidence-based management of acute lung injury and acute respiratory distress syndrome. Respiratory Care, 49(7), 793-809. doi:10.1001/jama.294.22.2889
Kao-Chang Lin, chik-Ho Chou,Wei-Lung Chang,Der-shin Ke ＆Jinn-Rung Kuo(2008).The early responase of Mannitol infusion in traumatic brain injury. Actue Neurologica Taiwanica.17(1),26-32. doi:10.1016/SO140-6736(02)08545-8
Kim, D. E., Lee, K. ., Jang, L. M., Roh, H., Ahn, M. Y., & Lee, J. (2012). Associations of cigarette smoking with intracranial atherosclerosis in the patients with acute ischemic stroke. Clinical Neurology & Neurosurgery, 114(9), 1243-1247. doi: 10.1016/j.clineuro.2012.03.012
Knaus, W. A. (1996). The ongoing mystery of ARDS. Intensive Care Med, 22(6), 517-518. doi : 10.1007/s001340050124
Koutsoukou, A., Perraki, H., Raftopoulou, A., Koulouris, N., Sotiropoulou, C., Kotanidou, A.,…Roussos, C. (2006). Respiratory mechanics in brain-damaged patients. Intensive Care Med, 32(12), 1947-1954. doi: 10.1007/s00134-006-0406-0
Kraus, J. F., Black, M. A., & Hessol, N.(1984). The incidence of acute brain injury and serious impairment in a defined population. Am J epidemiol, 119, 186-201. doi: 10.1080/02699050600664368
Kuo, J. R., Yeh, T. C., Sung, K. C., Wang, C. C., Chen, C. W., & Chio, C. C. (2006). Intraoperative applications of intracranial pressure monitoring in patients with severe head injury. Journal of Clinical Neuroscience, 13, 218-223. doi : 10.1016/j.jocn.2005.01.012
Ley, E J., Berry, C., Mirocha, J., & Salim, A. (2010). Mortality is Reduced for Heart Rate 80 to 89 After Traumatic Brain Injury. Journal of Surgical Research, 163, 142-145. doi: 10.1016/j.jss.2010.04.046
Lin, J. W., Tsai, S. H., Tsai, W. C., Chiu, W. T., Chu, S. F., Lin, C. M., ...Hung, C.C. (2006). Survey of traumatic intracranial hemorrhage in Taiwan. Surgical Neurology, 66, S2:20-S2:25. doi: 10.1016/j.surneu.2006.04.005
Lou, M., Chen, X. Z., Wang, K., Xue, Y., Cui, D., & Xue, F. (2013). Increased intracranial pressure is associated with the development of acute lung injury following severe traumatic brain injury. Clinical Neurology and Neurosurgery, 115(7), 904-908. doi: 10.1016/j.clineuro.2012.09.001
Mascia, L., Grasso, S., Fiore, T., Bruno, F., Berardino, M., Ducati, A. (2005) Cerebto-pulmonary interactions during the application of low levels of positive end-expiratory pressure. Intensive Care Med, 31, 373-379. doi: 10.1016/S0734-3299(08)70162-X
Mascia, L., Zavala, E., Bosma, K., Pasero, D., Decaroli, D., Andrews, P.,…
Ducati, A. (2007). High tidal volume is associated with the development of acute lung injury after severe brain injury: an international observational study. Critical Care Medicine, 35(8), 1815-1820. doi: 10.1097/01.CCM.0000275269.77467.DF
Mascia, L. (2009). Acute lung injury in patients with severe brain injury: A double hit model. Neurocritical Care, 11(3), 417-426. doi: 10.1007/s12028-009-9242-8
McGuire, G., Crossley, D., Richards, J., & Wong, D. (1997). Effects of varying levels of positive end-expiratory pressure on intracranial pressure and cerebral perfusion pressure. Critical Care Medicine, 25(6), 1059-1062. Doi: 10.1097/00003246-199706000-00025
McNett, M., Amato, S., Gianakis, A., Grimm, D., Philippbar, SA., Belle, J., Moran, C. (2014). The Four Score and GCS as Predictors of Outcome After Traumatic Brain Injury. Neurocritical Care. doi: 10.1007/s12028-013-9947-6
Moller, J. T., Johannessen, N. W., Berg, H., Espersen, K., & Larsen, L. E. (1991). Hypoxemias during an aesthesia--an observer study. British Journal of Anaesthesia, 66(4), 437-444. doi: 10.1093/bja/66.4.437
Monchi, M., Bellenfant, F., Cariou, A., Joly, L. M., Thebert, D., Laurent, I., . . . Brunet, F. (1998). Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis. Am J Respir Crit Care Med, 158(4), 1076-1081. doi: 10.1164/ajrccm.158.4.9802009
Mortínez-Pérez, M., Bernabé, F., Peňa, R., Fernández, R., Nahum, A., & Blanch, L. (2004). Effects of expiratory tracheal gas insufflation in patients with severe head trauma and acute lung injury. Intensive Care Medicine, 30, 2021-2027. doi:10.1007/s00134-004-2439-6
Neumann, P., Rothen, H. U., Berglund, J. E., Valtysson, J., Magnusson, A., & Hedenstierna, G. (1999). Positive end-expiratory pressure prevents atelectasis during general anaesthesia even in the presence of a high inspired oxygen concentration. Acta Anaesthesiol Scand, 43(3), 295-301. Doi: 10.1034/j.1399-6576.1999.430309
Panerai, R.B., Kerins, V., Fan, L., Yeoman, P. M., Hope, T., & Evans, D. H. (2004). Association between dynamic cerebral autoregulation and mortality in severe head injury. British Journal of Neurosurgery, 18(5), 471-479. doi:10.1080/02688690400012343
Pettus, E. H., Christman, C. W., Giebel, M. L., & Povlishock, J. T. (1994). Traumatically induced altered membrane permeability: its relationship to traumatically induced reactive axonal change. J Neurotrauma, 11(5), 507-522. doi : 10.1089/neu.1994.11.507
Pillai, S., Praharaj, S. S., Rao, G. S. U., & Kolluri, V. R. S. (2004). Cerebral perfusion pressure management of severe diffuse head injury: Effect on brain compliance and intracranial pressure. Neurology India March, 52(1), 67-71. doi: 10.1007/978-3-7091-6738-0_45
Ponsford, J L., Myles, P S., Cooper, D. J., Mcdermott, F T., Murray, L J., Laidlaw, J., Cooper, G., Tremayne, A B., & Bernard, S A. (2008). Gender differences in outcome in patients with hypotension and severe traumatic brain injury. International Journal of the care of the inured, 39, 67-76. doi:10.1016/j.injury.2007.08.028
Povlishock, J. T., Erb, D. E., & Astruc, J. (1992). Axonal response to traumatic brain injury: reactive axonal change, deafferentation, and neuroplasticity. J Neurotrauma, 9 (Suppl 1), S189-S200. doi: 10.3109/02699052.2012.743179
Qu, X. D., Shrestha, R., & Wang, M. D. (2011). Risk factors analysis on traumatic brain injury prognosis. Chinese medical sciences journal, 26 (2), 98-102. doi:10.1016/S1001-9294(11)60027-8
Roupie, E., Dambrosio, M., Servillo, G., Mentec, H., el Atrous, S., Beydon, L., . . . Brochard, L. (1995). Titration of tidal volume and induced hypercapnia in acute respiratory distress syndrome. Am J Respir Crit Care Med, 152(1), 121-128. doi:10.1164/ajrccm.152.1.7599810
Roy, G., & Michacl, A. (2000). Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med, 342(18), 1301-1308. doi: 10.1056/nejm200005043421801
Runge, J. W. (1993). The cost of head injury. Emergency Medication clinical North America, 11 (1), 241-253.doi: 10.1016/0736-4679(93)90343-6
Singh, P K., Marzo, A., Howard, B., Rufenacht, D A., Bijlenga, P., Frangi, A F., … Patel, U J. (2010). Effects of smoking and hypertension on wall shear stress and oscillatory shear index at the site of intracranial aneurysm formation. Clinical Neurology & Neurosurgery, 112(4), 306-313. doi: 10.1016/j.clineuro.2009.12.018
Stewart, T. E., Meade, M. O., Cook, D. J., Granton, J. T., Hodder, R. V., Lapinsky, S. E., . . . Slutsky, A. S. (1998). Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. Pressure- and Volume-Limited Ventilation Strategy Group. N Engl J Med, 338(6), 355-361. doi: 10.1056/nejm199802053380603
Tsai, M. D., Chiu, W. T., Lin, J. W., Chen, C. F., Huang, S. J., Chang, C. K.,….Tsai, S. H. (2006). Current experiences in the use of the severe head-injruy guidelines in Taiwan. Surgical Neurology, 66, S2:3- S2:7.doi:10.1016/j.surneu.2006.02.046
Teasdale, G., & Jennett, B. (1974). Assessment of coma and impaired consciousness a practical scale. Lancet, 11, 480-486.doi: 10.1016/S0140-
6736(74)91639-0
Tian, H. L., Xu, T., Hu, J., Cui, Y. H., Chen, H., & Zhou, L. F. (2008). Risk factors related to hydrocephalus after traumatic subarachnoid hemorrhage. Surgical Neurology, 69, 241-246. doi: 10.1016/j.surneu.2007.02.032
Utomo, W K., Gabbe, B J., Simpson, P M., & Cameron, P A. (2009). Predictors of in-hospital mortality and 6-month functional outcomes in older adults after moderate to severe traumatic brain injury. Injury, Int. J. Care Injured, 40, 973-977. doi: 10.1016/j.injury.2009.05.034
Zeng, T., & Gao, L., (2010).Management of patients with severe traumatic brain injury guided by intraventricular intracranial pressure monitoring: a report of 136 cases. Chinese Journal of Traumatology, 13(3), 146-151.
doi: 10.3760/cma.j.issn.1008-1275.2010.03.003
Zygun, D. A., Kortbeek, J. B., Fick, G. H., Laupland, K. B., & Doig, C. J. (2005). Non-neurologic organ dysfunction in severe traumatic brain injury. Critical Care Medicine, 33(3), 654-660. doi: 10.1097/01.CCM.0000155911.01844.54