重型颅脑损伤的颅内压与预后及其在大骨瓣减压术中的变化  

Correlations between intracranial pressure and outcome in patients with severe traumatic brain injury and its changes during decompressive craniectomy

作　　者：张旗林[1] 张敬泉[1] 张弛[1] 彭涛[1] 袁林[1] 周晓平[2] 

机构地区：[1]上海市第七人民医院神经外科,200137 [2]第二军医大学附属长海医院神经外科

出　　处：《临床神经外科杂志》2017年第2期148-150,共3页Journal of Clinical Neurosurgery

基　　金：上海中医药大学附属第七人民医院人才培养计划资助(QMX2015-02)

摘　　要：目的探讨重型颅脑损伤患者颅内压(ICP)与预后的关系,以及大骨瓣减压术中ICP的变化。方法回顾性分析58例重型颅脑损伤患者大骨瓣减压术前、术中和术后的ICP值。术后6个月时评估患者的预后,对术前不同ICP患者的预后进行比较。结果本组患者在大骨瓣减压术前、骨瓣去除后、硬脑膜切开后、血肿清除后和关颅后的平均ICP,分别为(45.48±10.09)mm Hg、(29.84±5.21)mm Hg、(8.86±3.78)mm Hg、(10.15±4.12)mm Hg和(11.41±5.26)mm Hg。减压术前ICP>60 mm Hg患者的预后不良率和术中急性脑膨出发生率均显著高于ICP<40 mm Hg和40~60 mm Hg的患者(均P<0.05)。减压术中大骨瓣去除后和硬脑膜切开后的ICP均较术前明显下降(均P<0.05)。结论重型颅脑损伤后ICP明显增高患者的预后较差,应警惕患者术中发生急性脑膨出。大骨瓣减压的同时充分切开硬脑膜能最大程度地降低ICP。Objective To explore the between intracranial pressure（ ICP） and outcome in patients with severe traumatic brain injury（ s TBI） and its changes during decompressive craniectomy（ DC）. Methods 58 cases of severe TBI treated by DC following ICP probes implanted were analysed retrospectively. The value of ICP at the time point of pre-DC,Intra-DC and Post-DC were measured by ICP. The outcome of patients was evaluated at 6 months after injury.The relationship between the initial ICP before DC and outcome was analyzed. Results The average values of ICP pre-DC,removal of bone flap,after dural opening,hematoma removing and the closure of scalp were（45. 48 ± 10. 09） mm Hg,（29. 84 ± 5. 21） mm Hg,（8. 86 ± 3. 78） mm Hg,（10. 15 ± 4. 12） mm Hg and（11. 41 ±5. 26） mm Hg. Comparing with the values of ICP pre-DC,ICP significantly decreased after removal of bone flap and dural opening（ all P〈0. 05）. The incidence of acute encephalocele and poor outcomes were significantly different（ all P〈0. 05） in the patients with ICP〉 60 mm Hg. Conlusion To obtain the greatest effective reduction of ICP,extensive dural opening while DC is necessary. The patients with preoperative ICP 60 mm Hg should be alert to the occurrence of acute encephalocele.

关 键 词：重型颅脑损伤 大骨瓣减压 颅内压监测 

分 类 号：R651.1[医药卫生—外科学]