无创脑水肿动态监测在创伤性脑损伤术后的临床应用价值  

Clinical value of dynamic noninvasive monitoring technique after operation for traumatic brain injury

作　　者：秦兴虎 陈义天 徐宏[1] 刘亮 陈玉秋 陈礼刚 江涌 

机构地区：[1]德阳市人民医院神经外科,618000 [2]苏州大学医学部 [3]西南医科大学附属医院神经外科

出　　处：《中华创伤杂志》2017年第8期719-723,共5页Chinese Journal of Trauma

基　　金：国家自然科学青年基金（81000528）;新世纪优秀人才支持计划基金（NCET-12-1057）;四川省科技厅杰出青年基金（2014JQ0022）

摘　　要：目的探讨无创脑水肿动态监护在创伤性脑损伤（TBI）开颅手术后再出血及继发脑水肿等中的临床价值。方法采用回顾性病例系列研究分析196例接受开颅手术的中、重型TBI患者资料，其中男128例，女68例；年龄18—60岁，中位年龄36．5岁。术前格拉斯哥昏迷评分（GCS）6～8分89例，9～12分107例。手术时置入颅内压探头，常规行有创颅内压监护并记录颅内压值。术后采用BORN—BE无创脑水肿动态监护仪连续观察双侧大脑半球脑电阻抗扰动系数（CEI）变化。结果术后继发性脑水肿所致CEI改变与颅内压呈正相关，CEI随颅内压的升高而升高，颅内压越高，CEI越大（R=0．954，R^2=0．910，P〈0．05）。术后再出血均发生于术后24h内，出血体积为（22．19±14．08）ml，出血侧CEI显著降低，且出血体积与CEI呈负相关（R=-0．982，R^2=0．964，P〈0．05）。结论TBI开颅术后使用无创脑水肿动态监护仪观察CEI，不仅能反映TBI术后脑水肿严重程度，还能预估再出血及出血体积，对于制订治疗方案具有重要意义。Objective To investigate the clinical value of noninvasive monitoring technique in intracranial hemorrhage and secondary brain edema after operation for traumatic brain injury （TBI）. Methods A retrospective case-series analysis was done on 196 TBI patients （ 128 males and 68 females, aged 18-60 years old, median age 36.5 years old） admitted from January 2014 to December 2015 and treated surgically with simultaneous implantation of intracranial pressure （ICP） probe. There were 89 patients with Glasgow coma score （GCS） 6-8 points and 107 with GCS 9-12 points. The values of ICP were recorded. The changes of cerebral electrical impedance （CEI） were monitored in all patients through the BORN-BE noninvasive monitor. Results The disturbance factor of the BORN-BE noninvasive monitor in brain edema in the cerebral stage exhibited a strongly positive correlation with ICP （R =0.954, R2 =0.910, P 〈 0.05 ）. All the rebleeding occurred within 24 hours after operation in the study. The disturbance factor showed a significant reduction in the bleeding side, which exhibited a strongly negative correlation with the volume of cerebral hemorrhage （ R = - 0.982, R^2 = 0. 964, P 〈 0.05 ）. Conclusion After operation for TBI, the ICE changes from dynamic noninvasive monitor can reflect the severity of brain edema digitally, indicating that the postoperative rebleeding and its volume may play an important role in selection of optimal treatment.

关 键 词：脑损伤 脑水肿 颅内出血 脑电阻抗 

分 类 号：R651.15[医药卫生—外科学]