无创联合有创颅内压监测在外伤性脑肿胀治疗中的应用  

Clinical Study on Noninvasive and Simple Invasive Intracranial Pressure Monitoring in Acute Traumatic Brain Swelling

作　　者：张佳兴 肖灿[1] 石磊[1] 刘宇 罗嫩苗 赵振宇[1] 李江 陈静[1] 

机构地区：[1]解放军163医院(湖南师范大学第二附属医院)神经外科,湖南长沙410003

出　　处：《中国现代手术学杂志》2017年第5期395-397,共3页Chinese Journal of Modern Operative Surgery

基　　金：2013年度湖南省教育厅科学研究一般项目(13C553)

摘　　要：目的探讨闪光视觉诱发电位无创和简易有创颅内压联合监测颅内压(ICP)值对治疗外伤性急性脑肿胀的指导作用以及临床意义。方法 2010年1月~2014年12月我科运用无创颅内压和简易有创颅内压联合监测治疗外伤性急性脑肿胀患者39例。GCS评分3~5分8例,6~8分17例,9~12分14例。CT中线移位<5 mm者11例,5~10 mm者10例,中线移位>10 mm者6例,双侧弥漫性脑肿胀12例。根据患者初始ICP值分为三种类型:(1)轻度颅高压型(ICPl5~25 mm Hg)11例;(2)中度颅高压型(ICP25~35 mm Hg)13例;(3)重度颅高压型(ICP>35 mm Hg)15例。结果本组轻、中、重型患者预后良好率分别为90.1%(10/11)、61.5%(8/13)和20%(3/15),预后不良率分别为9.1%(1/11)、38.5%(5/13)和80%(12/15);组间比较差异有统计学意义(P<0.05)。结论外伤性急性脑肿胀患者入院时ICP值与患者预后密切相关;运用无创及有创ICP联合监测患者颅内压简单实用,可在基层医院积极推广应用;同时联合脑室外引流术对治疗外伤性急性脑肿胀有重要的临床指导作用。Objective To investigate the effect of flash visual evoked potential（FVEP） noninvasive intracranial pressure（ICP） monitoring combined with simple invasive ICP monitoring in the treatment of acute traumatic brain swelling. Methods A lot of 39 cases suffered acute traumatic brain swelling carried out noninvasive and simple invasive ICP monitoring admitted from January 2010 to December 2014 were analyzed retrospectively. The GCS scored 3 to 5 in 8 cases,6 to 8 in 17 cases and 9 to 12 in 14 cases. CT scanning showed midline shift 〈5 mm in 11,5 to 10 mm in 10,〉 10 mm in 6 and bilateral diffuse cerebral swelling in 12 cases. According to initial ICP,all cases were divided into three types： 11 of mild intracranial hypertension type（ICP l5 ~ 25 mm Hg）,13 of mid intracranial hypertension type（ICP 25 ~ 35 mm Hg） and 15 of severe intracranial hypertension type（ICP 〉35 mm Hg）. Results The eusemia rate of mild,mid and severe intracranial hypertension patients was 90. 1%（10/11）,61. 5%（8/13） and 20%（3/15）,the unfavourable prognosis rate was 9. 1%（1/11）,38. 5%（5/13） and 80%（12/15）; there was statistic differences between two groups（P〈0. 05）. Conclusions The initial ICP is correlated to prognosis in the acute traumatic brain swelling patients. The technique of FVEP noninvasive combined with simple invasive ICP monitoring is manipulative and practical,and can be popularized in basic hospital. The ICP monitoring combined with external ventricular drainage can play an important role in the treatment of acute traumatic brain swelling.

关 键 词：脑水肿 脑损伤 颅内压监测 闪光视觉诱发电位 预后 

分 类 号：R651.15[医药卫生—外科学]