颅内压监测在高龄颅脑外伤患者中的应用  

Application of intracranial pressure monitoring in elderly patients with craniocerebral trauma

作　　者：凌聪[1] 叶卓鹏[1] 侯博[1] 蔡梅钦[1] 

机构地区：[1]中山大学附属第三医院神经外科,广东广州510630

出　　处：《中国实用神经疾病杂志》2018年第2期177-179,共3页Chinese Journal of Practical Nervous Diseases

基　　金：广东省科技计划项目(编号:2015A020212016)

摘　　要：目的探讨颅内压监测在高龄颅脑外伤患者救治中的意义。方法回顾性分析2014-04—2016-06于中山大学附属第三医院治疗的高龄颅脑外伤患者85例。观察组45例于受伤24h内行ICP监测,平均监测时间(6.14±1.5)d;观察组ICP持续>20mmHg时应用脱水治疗,若持续>25mmHg,应用脱水药物效果不明显,且患者意识进行性下降、连续头部CT显示脑内血肿增加或脑水肿加重的患者施行手术。对照组40例采用常规治疗,根据经验决定脱水和手术方案。比较2组脱水药物用量及预后。结果观察组人均甘露醇使用剂量为(30.4±16.3)g/d,较对照组的(45.8±15.3)g/d减少,差异有统计学意义(P<0.01)。观察组病死率较对照组低,植物生存状态少,差异有统计学意义(P<0.05)。结论持续颅内压监测可提高高龄颅脑外伤患者的疗效,并可评估病情及预后,具有重要的临床意义。Objective To explore the significance of intracranial pressure monitoring in elderly patients with craniocerebral trauma treatment. Methods A retrospective analysis was conducted about 85 elderly patients with craniocerebral injury at The third affiliated hospital of Sun-Yat-Sen University between April 2014 to June 2016.45 patients in observation group had accepted ICP monitoring within 24 hours after injured,the average time of monitoring was （6.14 ± 1.5） d. When ICP〉20 mm Hg in ob servation group,dehydration treatment was implemented;when ICP〉25 mm Hg continuously, and the effect of dehydration was not obvious,or patients with progressive decline in consciousness, repeated head CT showed hematoma increase or surgery in pa- tients with cerebral edema aggravated, operation was conducted. The control group （40 cases） were treated by routine therapy, including dehydration and operation based on experience. We compared dehydration drug dosage and prognosis of two groups. Results The per capita mannitol dosage of observation group was （30.4 ± 16.3） g/d,compared with control group （45.8 ± 15.3） g/ d, the difference was statistically significant （P〈0.01）. Mortality and plant condition of observation was lower than those of control group, the difference was also statistically significant （P〈0.05）. Conclusion Continuous intracranial pressure monitoring has important clinical significance in improving the curative effect and assessing the condition and prognosis in elderly patients with craniocerebral trauma.

关 键 词：颅内压监测 高龄 颅脑外伤 脑内血肿 预后 

分 类 号：R651.15[医药卫生—外科学]