硬膜下颅内压监护在重型颅脑损伤术后的临床应用  

Clinical value of monitoring subdural intracranial pressure in post-operative patients with severe brain injury

作　　者：陈再丰[1] 许信龙[1] 傅小君[1] 魏晓捷[1] 潘红松[1] 谢青松[1] 

机构地区：[1]慈溪市人民医院神经外科,315300

出　　处：《中华创伤杂志》2009年第8期729-732,共4页Chinese Journal of Trauma

基　　金：宁波市自然科学基金资助项目（2008A610093）

摘　　要：目的探讨重型颅脑损伤患者术后持续颅内压（ICP）监护的价值。方法选择100例重型颅脑损伤开颅手术患者，分为ICP监护组（50例）和常规治疗组（50例），ICP监护组根据颅内压的变化随时调整治疗方案，常规治疗组根据经验进行常规神经外科治疗。结果ICP监护组术后平均应用甘露醇的时间为8d，平均剂量为950g；常规治疗组术后平均应用甘露醇的时间为12d，平均剂量为1450g。两组在甘露醇应用时间及剂量方面差异均有统计学意义（P〈0．01）。ICP监护组50例中术后发生电解质紊乱4例（8％），急性肾功能损害7例（14％），应激性溃疡4例（8％），肺部感染8例（16％）；常规治疗组50例中术后发生电解质紊乱9例（18％），急性肾功能损害14例（28％），应激性溃疡5例（10％），肺部感染9例（18％）。两组术后电解质紊乱及急性肾功能损害并发症的发生率比较，差异有统计学意义（P〈0．05），而应激性溃疡和肺部感染并发症的发生率比较，差异无统计学意义（P〉0．05）。ICP监护组患者术后ICP初值与患者死亡率呈负相关（P〈0．01）；全部患者经3个月随访，ICP监护组50例中恢复良好27例（54％），轻残13例（26％），重残2例（4％），植物生存3例（6％），死亡5例（10％）；常规治疗组50例中恢复良好17例（34％），轻残6例（12％），重残6例（12％），植物生存8例（16％），死亡13例（26％），两组预后差异有统计学意义（P〈0．05）。结论重型颅脑损伤患者术后连续ICP监护对减少术后并发症、降低死亡率、改善预后有重要价值。Objective To investigate the value of subdural intracranial pressure （ICP） monitoring in post-operative patients with severe brain injury. Methods A total of 100 patients with severe brain injury treated with craniotomy were randomly divided into ICP monitoring group （n = 50） and routine treatment group （ n = 50）. In ICP monitoring group, the treatment methods were adjusted according to the changes of ICP, whereas the patients in routine treatment group underwent general treatment according to standard neurosurgical protocol. Results Patients in ICP monitoring group received mannitol for eight days, with the average dosage of 950 g. Mannitol was administered to patients in routine treatment group for 12 days, with average dosage of 1 450 g. There was statistical difference in aspects of time duration and mannitol dosage between two groups （P 〈 0.01 ）. Of all patients in ICP monitoring group, four were found with electrolyte disturbance （8%）, seven with acute renal failure （14%）, four with stress ulcer （8%） and eight with pulmonary infection （16%）. The corresponding numbers of patients in routine treatment group were nine （ 18% ） , 14 （28%） , five （ 10% ） and nine （ 18% ） , respectively. The occurrence of electrolyte disturbance and acute renal failure between two groups showed significant statistical difference （ P 〈 0.05 ）, while the occurrence of stress ulcer and pulmonary infection were beyond of statistical difference between two groups （ P 〉 0.05 ）. The post-operative initial ICP level was positively correlated with mortality rate （ P 〈 0.01 ）. All patients were followed up for three months post- operatively. In ICP monitoring group, 27 patients （26%） obtained good prognosis without any disability （54%）, 13 were under mild disability, two （4%） under severe disability , three （6%） under vegetatire state and five （ 10% ） died . In the routine treatment group, 17 patients （34%） were with good prognosis without any disabi

关 键 词：硬膜下腔 脑损伤 颅内压 预后 

分 类 号：R651.15[医药卫生—外科学] R743.3[医药卫生—临床医学]