动态颅内压监测对重型颅脑损伤标准大骨瓣减压术后治疗的意义  

Clinical value of ICP monitoring in severe traumatic brain injury after standard large decompressive craniectomy

作　　者：刘保华[1] 熊方令[1] 蔡旺[1] 张建永[1] 高行德[1] 袁璞[1] 张怀兵[1] 姜宁[1] 高明明[1] 

机构地区：[1]江苏省宿迁市人民医院神经外科,223800

出　　处：《临床神经外科杂志》2014年第2期128-130,共3页Journal of Clinical Neurosurgery

摘　　要：目的探讨动态颅内压(ICP)监测对重型颅脑损伤(sTBI)标准大骨瓣减压术治疗的指导意义。方法对62例(监测组)sTBI标准大骨瓣减压患者术后行ICP监测,根据ICP值调整治疗方案,并与同期未行ICP监测的46例(常规组)sTBI标准大骨瓣减压患者的疗效、并发症及甘露醇应用的时间和计量作比较。结果监测组脱水剂应用时间及剂量较未监测组低,监测组急性肾功能损伤和电解质紊乱发生率较未监测组低,而肺部感染、尿路感染和上消化道出血等三种并发症方面差异无统计学意义;监测组预后优于常规组。结论动态ICP监测能较好地反应sTBI标准大骨瓣减压术后ICP的变化,通过个体化治疗能有效控制ICP,维持脑灌注压,减少并发症,降低sTBI的致残率和病死率。Objective To investigate the significance of intracranial pressure （ICP） monitoring in severe traumatic brain injury （ sTBI ） patients after standard large trauma craniectomy .Methods 62 patients （ monitoring group ） who underwent ICP monitoring were treated according to the ICP values after standard large trauma craniectomy ,and 46 patients （ control group ） without ICP monitoring were treated according to experience .Then,the comparison of the time and dose of mannitol application , complications and prognosis in the two groups were performed .Results The time and dose of mannitol application in the monitoring group was less than the control group .And the rate of acute kidney injury and electrolyte disorder in the monitoring group was less than that in control group , but there was no significant difference in the rate of pulmonary infection , urinary tract infection and hemorrhage of upper digestive tract between the two groups .The prognosis in the monitoring group was better than the control group .Conclusions Dynamic changes of ICP after decompressive craniectomy in patients with severe traumatic brain injury could be showed in the ICP monitor .We can effectively control ICP ,maintain cerebral perfusion pressure , reduce complications , morbidity and mortality by individualized treatment .

关 键 词：颅内压监测 重型颅脑损伤 预后 

分 类 号：R651.15[医药卫生—外科学]