重型颅脑损伤术后无创脑水肿监测的临床应用  

Non-invasive monitoring of postoperative cerebral edema in patients with severe craniocerebral trauma

作　　者：周杰[1] 何光祥[1] 陈玉秋[1] 酉建[1] 刘洛同[1] 明扬[1] 陈礼刚 

机构地区：[1]泸州医学院附属医院神经外科,四川泸州646000

出　　处：《中国临床神经外科杂志》2015年第3期144-146,共3页Chinese Journal of Clinical Neurosurgery

基　　金：泸州医学院附属医院科研项目[(2013)60];四川省卫生厅科研基金(130360)

摘　　要：目的探讨无创脑水肿动态监测在重型颅脑损伤患者术后的应用价值。方法选择54例重型颅脑损伤患者为观察组,选择同期54例脑震荡患者为对照组。观察组采用BORN-BE无创脑水肿动态监护仪连续监测患者开颅手术后双侧大脑半球脑电阻抗（CEI）扰动系数的变化。结果手术前,观察组手术侧CEI扰动指数较对照组显著降低（P〈0.05）,非手术侧与对照组无统计学差异（P〉0.05）。术后1、12-14 d,观察组手术侧、观察组非手术侧与对照组CEI扰动指数,两两之间均无统计学差异（P〉0.05）,但观察组手术侧术后2-11 d CEI扰动指数明显高于对照组（P〈0.05）。观察组手术侧CEI扰动系数术后2 d逐渐增加,术后4-7 d达高峰,然后逐渐减低,至术后12 d与对照组无明显差异（P〉0.05）。观察组手术侧CEI扰动系数异常波动共12例,CT示术区脑水肿11例;非手术侧CEI扰动系数异常波动共6例,CT示非手术区域脑水肿4例。结论 CEI扰动系数随重型颅脑损伤患者术后病程推移呈现动态变化,可动态评估患者脑水肿或血肿演变过程,指导临床颅内压处理方法的制定。Objective To explore the value of non-invasive monitoring dynamic brain edema to the clinical treatment in thepatients with severe craniocerebral trauma.MethodsThe changes in the cerebral electrical impendence perturbation coefficient（CEIPC）values of the bilateral hemispheres before the operation and 1-14 days after the operation were observed by BOEN-BE non-invasivebrain edema monitor in 54 patients with severe craniocerebral trauma. Fifty-four patients with cerebral concussion served as controlgroup.ResultsCEIPC value in the operated hemisphere before the operation was significantly lower in the observed group than that inthe control group（P〈0.05）. CEIPC values were significantly higher in the operated hemispheres in the observed group than those in thenon-operated hemisphere from 2 to 11 days after the operation in the observed group and in bilateral hemispheres of control group（P〈0.05）.ConclusionsThe dynamic changes in CEIPC values of the operated hemisphere are parallel to the development of the hemisphereedema after the operation in the patients with severe craniocerebral trauma, in whom CEIPC value is helpful to treating the cerebral edema.

关 键 词：重型颅脑损伤 颅内压 无创脑水肿监测 

分 类 号：R651.15[医药卫生—外科学] R651.11[医药卫生—临床医学]