有创颅内压和经颅多普勒联合监测在急性颅脑创伤救治中的作用  

Treatment for acute craniocerebral trauma with invasive intracranial pressure combined with transcranial Doppler monitoring

作　　者：王聪[1] 龙连圣[1] 辛志成 李夏良 蒋超超 苏强 吴钟华 王伟 章元 胡夷 施顺孝 Wang Cong Long Lian-sheng Xin Zhi-cheng Li Xia-liang Jiang Chao-chao Su Qiang Wu Zhong-hua Wang Wei Zhang yuan Hu Yi Shi Shun-xiao(Department of Neurosurgery, the 98th Clinical Academy of Anhui Medical University, Huzhou 313000, China)

机构地区：[1]安徽医科大学九八临床学院神经外科,浙江湖州313000 [2]解放军第九八医院神经外二科,浙江湖州313000

出　　处：《中国急救医学》2017年第1期61-64,共4页Chinese Journal of Critical Care Medicine

基　　金：南京军区医学科技创新资助项目（11Z002）

摘　　要：目的探讨有创颅内压（ICP）和经颅多普勒（TCD）联合监测对急性颅脑创伤救治的临床指导作用及对预后的预测。方法2010—01—2014—06解放军第九八医院神经外二科在有创ICP和TCD联合监测下救治急性颅脑创伤163例，分析人院时及伤（术）后3d的ICP和搏动指数（PI）与预后的关系。结果按伤后6个月格拉斯哥预后评分（GOS），恢复良好55例，中残47例，重残13例，植物生存16例，死亡32例。将恢复良好和中残归为预后较好组，将重残、植物生存和死亡归为预后不好组。预后较好组人院时ICP[（21．98±8．74）mmHg]显著低于预后不好组人院时ICP[（34．17±16．38）mmHg]（P〈0．001），预后较好组伤（术）后3d的ICP[（16．84±5．44）inmHg]显著低于预后不好组伤（术）后3d的ICP[（31．07±19．79）mmHg]（P〈0．001）。预后较好组和预后不好组人院时P1分别为1．52±0．42和1．66±0．69，差异无统计学意义（P〉0．05）；伤（术）后3d预后较好组和预后不好组P1分别为1．19±0．21和1．40±0．90，差异无统计学意义（P〉0．05）；入院时PI与伤（术）后3d PI差值预后较好组和预后不好组分别为0．34±0．07和0．23±0．09，差异有统计学意义（P〈0．05）。结论有创ICP及TCD联合监测对急性颅脑创伤救治有重要的临床指导作用，且对颅脑创伤的预后有预测作用。Objective To explore the clinical guidance and prediction of prognosis of invasive in- tracranial pressure （ICP） combined with transcranial Doppler （TCD） monitoring in treatment for patients with acute craniocerebral trauma. Methods A total of consecutive 163 patients with acute craniocerebral trauma admitted in our department accepting invasive ICP combined with TCD monitoring between Jan 2010 and Jun 2014 were enrolled in this retrospective study. The relationship between prognosis and ICP value as well as pulse index （PI） at admission and 3 days post-operation or after admission was analyzed. Results According to the Glasgow outcome score （GOS） 6 months after injury, among all the 163 patients, 55 cases got good recoveries, 47 cases got moderate disabilities, 13 cases suffered from severe disability, 16 patients became plant survival, and 32 cases died. Here, good recovery and moderate disabilities are kept in better prognosis group, and worse prognosis group includes severe disability, plant survival, and death. The ICP of better prognosis group at admission was （21.98±8.74） mm Hg, which was significantly lower than that of worse prognosis group being （34.17± 16.38） mm Hg （P 〈 0.001 ）. As well, the ICP on the third day after injury or operations were respectively （16.84±5.44） mm Hg and （31.07±19.79） mm Hg for better prognosis group and worse prognosis group; moreover, the difference between them was significant （P 〈 0.001 ）. The PI of better prognosis group at admission was （1.52±0.42）, and it was （ 1.66± 0.69） for worse prognosis group at admission, without statistics difference between them （P 〉 0.05）. As well, the PI 3 days after injury or operations were respectively （1.19±0.21） and （1.40±0.90） for better prognosis group and worse prognosis group, and the difference has no statistics significance. However, the PI difference at admission and 3 days after injury or operation were respectively （0.34±0.07） and （0.23± 0.09） for

关 键 词：颅脑创伤 有创颅内压(ICP) 经颅多普勒(TCD) 预后 

分 类 号：R651.15[医药卫生—外科学]