重症颅脑损伤术后患者颅内压监测对甘露醇用量及预后的影响  

Postoperative intracranial pressure monitoring reduces mannitol dose and improves prognosis in patients with severe brain injury

作　　者：陆骏[1] 施小燕[1] 

机构地区：[1]浙江大学医学院附属第二医院脑重症医学科,杭州310009

出　　处：《浙江医学》2012年第21期1721-1723,共3页Zhejiang Medical Journal

摘　　要：目的探讨重症颅脑损伤患者术后采取颅内压（ICP）监测对于其甘露醇用量及预后的影响.方法本组共68例重症颅脑损伤（GCS3-8分）术后患者,其中30例术后给予 ICP 监测（观察组）,并计算脑灌注压（CPP）,根据 ICP 情况调整治疗;38例未行 ICP 监测,按常规经验治疗控制 ICP（对照组）.比较两组28d,病死率及甘露醇用量.结果28d 病死率观察组30.0%,对照组57.9%,两组差异有统计学意义（P〈0.05）;观察组甘露醇用量（121.82±13.86）g、对照组（552.38±264.38）g,观察组明显较对照组用量减少（P〈0.01）;观察组中死亡者2535mmHg、CPP〈50mmHg 发生率均大于生存者（均 P〈0.05）.结论重症颅脑损伤术后患者进行 ICP 监测可以减少术后甘露醇用量并降低患者病死率,CPP〈50mmHg 可增加患者病死率.Objective To evaluate the relationship of postoperative intracranial pressure （ICP） monitoring with the dose of mannitol and the prognosis in patients with severe brain injury. Methods Sixty eight postoperative patients with brain injury whose GCS score were between 3 and 8 were enrolled in the study. Postoperative ICP monitoring was performed in 30 patients （ICP group） and the other 38 patients received conventional treatment to control brain edema. Results The 28-day mortality of ICP group was 30.0%, while that of control group was 57.9%（P〈0.05）. The amount of mannitol in ICP group was 121.82 ± 13.86g and that of control group was 552.38 _± 264.38g （P〈0.01）. In ICP monitoring group the incidence of 25〉lCP〈35mmHg, ICP〉 35mmHg or CPP 〈50 mmHg in fatal cases was greater than those in the survivals （P〈0.05）. Conclusion Postoperative ICP monitoring in patient with severe brain injury can reduce the dose of mannitol and improve the prognosis.

关 键 词：颅内压监测 严重颅脑损伤 颅内压 脑灌注压 

分 类 号：R651.15[医药卫生—外科学]