经颅多谱勒超声联合脑室型有创颅内压监测在创伤性双侧大脑半球弥漫性脑肿胀患者救治中的作用  

Effect of the combination of transcranial Doppler and invasive intracranial pressure monitoring in the treatment of post-traumatic bilateral cerebral hemisphere diffuse brain swelling patients

作　　者：龙连圣[1] 王伟[1] 王聪[1] 辛志成[1] 李夏良[1] 蒋超超[1] 吴钟华[1] 苏强[1] 章元[1] 胡夷 施顺孝 范顺志 Long Liansheng Wang Wei Wang Cong Xin Zhicheng Li Xialiang Jiang Chaochao Wu Zhonghua Su Qiang Zhang Yuan Hu Yi Shi Shunxiao Fan Shunzhi(Second Department of Neurosurgery, the 98th Hospital of Chinese People＇s Liberation Army, 98 Clinical College of Anhui Medical University, Huzhou 313000, China)

机构地区：[1]安徽医科大学解放军九八临床学院解放军第98医院神经外二科,浙江湖州313000

出　　处：《中华危重症医学杂志（电子版）》2016年第5期289-293,共5页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：2011年南京军区医学科技创新经费资助项目(11Z002)

摘　　要：目的探讨经颅多谱勒超声（TCD）联合脑室型有创颅内压（ICP）监测在创伤性急性双侧大脑半球弥漫性脑肿胀（PADBS）患者救治中的作用及对预后的影响。方法回顾性分析2013年3月至2015年12月解放军第98医院神经外二科在TCD联合脑室型有创ICP监测下救治的42例PADBS患者的临床资料。患者入院后2 h内行TCD及脑室型有创ICP监测,按入院首次ICP值分为ICP≤25 mm Hg组（27例）和ICP〉25 mm Hg组（15例）,同时按入院时首次TCD监测的脑搏动指数,分为脑搏动指数≤1.4组（18例）及脑搏动指数〉1.4组（24例）。同时按伤后6个月格拉斯哥预后评分（GOS）对患者预后进行评价。比较入院时不同ICP组及脑搏动指数组的预后情况。结果 PADBS患者入院首次ICP值15~46 mm Hg,平均ICP为（24±7）mm Hg;入院首次脑搏动指数值1.21~3.31,平均脑搏动指数为1.7±0.5。患者预后良好20例,中度残疾14例,重度残疾3例,植物生存3例,死亡2例。PADBS患者入院首次ICP≤25 mm Hg组预后优于ICP〉25 mm Hg组患者[92.59%（25/27）vs.60.00%（15/25）,χ2=4.695,P〈0.05]。入院首次脑搏动指数≤1.4组18例患者预后明显优于脑搏动指数〉1.4组患者[83.33%（15/18）vs.79.16%（19/24）,χ2=0.003,P〉0.05]。结论 TCD联合脑室型有创ICP监测对PADBS患者的临床救治有指导作用,且对患者预后有预测作用,其中入院首次ICP≤25mm Hg的PADBS患者预后较好。Objective To explore the clinical effect and prognosis prediction of the combination of transcranial Doppler（TCD） and ventricular invasive intracranial pressure（ICP）monitoring in the treatment of post-traumatic acute bilateral cerebral hemisphere diffuse brain swelling（PADBS） patients. Methods Forty-two PADBS patients who admitted to Second Department of Neurosurgery, the 98 th Hospital of Chinese People＇s Liberation Army from March2013 to December 2015 were enrolled in this retrospective study. They all accepted TCD and ventricular ICP monitoring within 2 h after admission. According to the initial ICP, patientswere divided into the ICP ≤ 25 mm Hg group（27 cases） and ICP〉25 mm Hg group（15 cases）.In addition, according to the brain pulsatility index（PI） detected by initial TCD after admission,patients were divided into the PI ≤ 1.4 group（18 cases） and PI〉1.4（24 cases）. Clinical outcome was determined based on the Glasgow outcome scale（GOS） 6 months after injury. The prognosis were compared between the different ICP groups and PI groups. Results The initial ICP of PADBS patients were 15-46 mm Hg（mean： 24 ± 7 mm Hg） after admission, and the initial PI were1.21-3.31（mean： 1.7 ± 0.5）. Twenty cases recovered well, 14 cases had moderate disability, 3cases had severe disability, 3 cases were at persistent vegetative state and 2 cases died. Twenty-five patients in the ICP ≤ 25 mm Hg group and 9 patients in the ICP〉25 mm Hg group recovered well.More patients in the ICP ≤ 25 mm Hg group recovered well as compared with the ICP〉25 mm Hg group [92.59%（25 / 27） vs. 60.00%（15 / 25）, χ2= 4.695, P〈0.05]. Fifteen patients in the PI ≤1.4 group and 19 patients in the PI〉1.4 group recovered well [83.33%（15 / 18） vs. 79.16%（19 /24）, χ2= 0.003, P〉0.05]. Conclusions The combination of TCD and ventricular invasive ICP monitoring could guide the clinical treatment for PADBS patients, and also help to predict the prognosis. The PADBS patients, wit

关 键 词：颅脑损伤 颅内压 弥漫性脑肿胀 经颅多谱勒超声 

分 类 号：R651.15[医药卫生—外科学]