持续颅内压监测防治颅脑创伤后肾功能损害  

Sustained intracranial pressure monitoring for prevention and treatment of kidney injury following craniocerebral trauma

作　　者：郭义君[1] 曾劲松[1] 童武松[1] 俞辉[1] 李永胜[1] 何斌[1] 杨文进[1] 李高义[1] 陈伟[1] 郑平[1] 

机构地区：[1]上海市浦东新区人民医院神经外科,201200

出　　处：《中华创伤杂志》2013年第4期316-319,共4页Chinese Journal of Trauma

基　　金：卫生部卫生行业科研专项基金资助项目（201002014）

摘　　要：目的探讨持续颅内压（ICP）监测指导颅脑创伤后甘露醇治疗对保护肾功能的效果。方法回顾性比较2010年1月-2012年1月收治的颅脑创伤患者168例。患者分为ICP监测组（ICP组，77例）和非ICP监测组（对照组，91例），动态观察患者血浆胱抑素c、肌酐和尿素的变化，记录甘露醇使用量、患者住院天数、6个月GOS评分等。结果两组在人院伤情、。肾功能、年龄、性别等方面差异无统计学意义。对照组肾功能衰竭发生率是ICP组的2．2倍（P〈0．05）。ICP组的甘露醇用量[（443±133）g]仅为对照组[（1620．-I-412）g]的27．35％（P〈0．01）；ICP组甘露醇使用时间[（4．8士3．8）d]也显著少于对照组[（7．2士2．3）d]（P〈0．01）；6个月GOS评分ICP组明显好于对照组（P〈0．05）；伤后第7，14和21天血浆胱抑素C、肌酐浓度和第14天尿素浓度ICP组均明显低于对照组（P〈0．05）。结论颅脑创伤治疗过程中采用ICP监测可显著减少甘露醇的用量与时间，有效预防和减少颅脑创伤后肾功能衰竭的发生。Objective To investigate effect of sustained intracranial pressure （ICP） monitoring in mannitol therapy for kidney function conservation after craniocerebral trauma. Methods A retrospective comparison was conducted on 168 patients with craniocerebral trauma treated between January 2010 and January 2012. The patients were divided into ICP monitoring group （ICP group, 77 patients） and non-ICP monitoring group （control group, 91 patients）. Changes of cystatin C, creatinine and urea in plasma were detected dynamically. Data like mannitol dosage, hospital days and GOS score at postoperative 6 months were documented. Results Two groups showed no significant differences regarding in-hospital injury condition, renal function as well as age and gender distribution. Rate of renal failure of control group was 2.2 times more than that of ICP group （P 〈 0.05 ）. Mannitol dosage of ICP group only accounted for 27.35% of that of control group, ie, （443 ＋133） g ： （1 620 ＋412） g （P〈 0.01 ）. Frequency of mannitol use of ICP group was obviously less than that of control group, ie, （4.8 ＋- 3.8） days vs （7.2 ＋2.3） days （P 〈0.01）. At 6 months postoperatively, GOS score of ICP group was significantly better than that of control group （ P 〈 0.05 ）. Plasma levels of cystatin C and creatinine at days 7, 14 and 21 and plasma levels of urea at day 14 were significantly lower of ICP group, when compared with control group （P 〈 0.05）. Conclusion ICP monitoring significantly reduces the dosage and duration of mannitol therapy for craniocerebral trauma and effectually prevents and declines the occurrence of renal failure following craniocrebral trauma.

关 键 词：颅脑损伤 颅内压 甘露醇 肾功能 

分 类 号：R651.15[医药卫生—外科学]