脑室型颅内压监测在不同年龄重型脑损伤患儿中的应用探讨  

Application of ventricular type intracranial pressure monitoring in children with severe brain injury at different ages

作　　者：荆俊杰[1] 赵清爽[1] 应建彬 陈帆 张桃桃 张尚明 曾子桓 宋云海 Jing Junjie;Zhao Qingshuang;Ying Jianbin;Chen Fan;Zhang Taotao;Zhang Shangming;Zeng Zihuan;Song Yunhai(Department of Neurosurgery,Fujian Children's Hospital(Fujian Branch of Shanghai Children's Medical Center),College of Clinical Medicine for Obstetrics,Gynecology&Pediatrics,Fujian Medical University,Fuzhou 350000,China;Department of Neurosurgery,No.900 Hospital of Joint Logistics Support Force,Fuzhou 350025,China)

机构地区：[1]福建省儿童医院(上海儿童医学中心福建医院)福建医科大学妇儿临床医学院神经外科,福州350000 [2]联勤保障部队第九〇〇医院神经外科,福州350025

出　　处：《临床小儿外科杂志》2023年第10期956-960,共5页Journal of Clinical Pediatric Surgery

基　　金：福建省省级临床重点专科建设项目-福建省儿童医院小儿神经外科(闽卫医政(2023)1163号)

摘　　要：目的分析脑室型颅内压监测在不同年龄儿童重型脑损伤中的应用结果,探讨其在儿童重型脑损伤治疗中的作用和意义。方法回顾性分析2017年6月至2022年3月,福建省儿童医院和联勤保障部队第九〇〇医院收治的成功应用颅内压监测的26例儿童重型脑损伤病例资料,其中男16例,女10例,年龄37 d至6岁,平均年龄1.3岁。根据年龄分为婴儿(<1岁)组15例和1~6岁组11例,经侧脑室额角穿刺植入Codman脑室型颅内压监测电极,并持续引流脑脊液,观察术前及术后1、3、7及14 d的儿童格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分、颅内压值及脑脊液引流量。结果26例患儿中,2例术后早期死亡,1例放弃治疗(出院后2 d死亡),病死率11.5%。婴儿组和1~6岁组GCS评分差异无统计学意义(P=0.235),婴儿组总体颅内压值低于1~6岁组(P=0.009),脑脊液引流量也低于1~6岁组(P<0.001),但组别与时间均无交互作用。婴儿组和1~6岁组不同时间点GCS评分差异有统计学意义(P<0.001),依次为:术前(7.31±0.85,6.40±1.43)、术后第1天(9.23±1.09,8.50±1.84)、术后第3天(11.38±1.19,10.40±2.59)、术后第7天(13.08±0.95,12.70±2.36)、术后第14天(14.38±0.77,13.90±0.99);各时间点颅内压差异有统计学意义(P<0.001),依次为:术中(26.00±4.00,30.70±3.74)mmHg、术后第1天(20.38±4.35,22.10±3.98)mmHg、术后第3天(15.77±4.19,19.60±4.58)mmHg、术后第7天(10.54±1.61,14.10±3.63)mmHg、术后第14天(6.31±1.18,8.40±1.35)mmHg;各时间点脑脊液引流量差异也具有统计学意义(P<0.001),依次为:术后第1天(51.54±14.91,97.20±23.30)mL、术后第3天(69.23±12.89,100.60±25.29)mL、术后第7天(86.15±15.57,139.30±28.12)mL、术后第14天(82.69±10.13,137.80±17.08)mL,但组别与时间无交互作用。结论儿童重型脑损伤后应用脑室型颅内压监测,婴儿组和1~6岁组在术后随着时间变化的预后过程基本一致,脑脊液引流量逐步增加,颅内压逐步下降,GCS评分Objective To explore the application outcomes of ventricular intracranial pressure(ICP)monitoring at different ages and explore its role in the treatment of severe brain injury in children.Methods From June 2017 to March 2022,retrospective review was performed for 26 children with severe brain injury.ICP was successfully monitored.With a male-to-female ratio of 16∶10,they had an average age of 1.3 years(37 days to 6 years).Based upon age,they were assigned into two groups of infant aged under 1 year(n=15)and(1-6)year(n=11).Ventricular type ICP monitoring electrode(Codman)was implanted into lateral ventricles and cerebrospinal fluid(CSF)continuously drained.GCS score,ICP and CSF drainage were observed at pre-op and Day 1/3/7/14 post-op.Results The overall mortality rate was 11.5%.Two cases died early post-op and another one pausing treatment passed away at Day 2 post-discharge.No statistically significant inter-group difference existed in Glasgow coma scale(GCS)score(P=0.235).The overall ICP was lower in infant group than that in(1-6)year group(P=0.09).Drainage volume of CSF was also lower than that in(1-6)year group(P<0.001).However,there was no interaction between group and time.Statistical significance existed in GCS scores at different timepoints within each group(P<0.001).GCS scores of infant and(1-6)year groups at pre-op(7.31±0.85;6.40±1.43)<post-op Day 1(9.23±1.09;8.50±1.84)<post-op Day 3(11.38±1.19;10.40±2.59)<postoperative Day 7(13.08±0.95;12.70±2.36)<post-op Day 14(14.38±0.77;13.90±0.99).Significant statistical differences existed in ICP values(mmHg)at different timepoints(P<0.001).That is,intra-op(26.00±4.00;30.70±3.74)>post-op Day 1(20.38±4.35;22.10±3.98)>post-op Day 3(15.77±4.19;19.60±4.58)>post-op Day 7(10.54±1.61;14.10±3.63)>post-op Day 14(6.31±1.18;8.40±1.35).The difference in drainage volume of CSF(ml)at each timepoint was also statistically significant(P<0.001).That is,post-op Day 1(51.54±14.91;97.20±23.30)<post-op Day 3(69.23±12.89;100.60±25.29)<post-op Day 7(86.15±15.

关 键 词：颅内压监测 脑损伤 儿童 

分 类 号：R726.5[医药卫生—儿科]