重度颅脑损伤开颅术后早期颅内压与CRP和D-二聚体的相关性  

Relationship of early intracranial pressure with C-reactive protein and D-Dimer in patients with severe traumatic brain injury after craniotomy

作　　者：贾继明[1] 王起[2] 郭辉[1] 马仁政[1] JIA Jiming;WANG Qi;GUO Hui;MA Renzheng(Department of Neurosurgery, Space Center Hospital, Beijing 100049, China;Department of Neurology, Space Center Hospital, Beijing 100049, China)

机构地区：[1]航天中心医院神经外科,北京100049 [2]航天中心医院神经内科,北京100049

出　　处：《临床与病理杂志》2019年第1期90-97,共8页Journal of Clinical and Pathological Research

摘　　要：目的:探讨重度颅脑损伤患者接受开颅术后早期颅内压(intracranial pressure,ICP)与患者脑脊液及外周血CRP和D-二聚体(D-dimer,D-D)的相关性,为判断重度颅脑损伤病情发展提供参考。方法:纳入2015年1月至2017年12月于航天中心医院神经外科接受治疗的37例重度颅脑损伤、接受开颅术患者,均于术后留置颅内测压导管,持续监测ICP。术后3 d内,每12 h采集患者脑脊液及外周血标本,采用免疫比浊法检测CRP和D-D水平,并统计对应时点ICP指标。结果:37例患者共获得6组、222份数据,其中105份ICP>20 mmHg,117份ICP≤20 mmHg。ICP>20 mmHg时患者血清CRP、血清D-D、脑脊液CRP、脑脊液D-D水平均明显高于ICP≤20mmHg时的水平(P<0.05)。血清CRP、血清D-D、脑脊液CRP、脑脊液D-D与ICP均呈明显正相关(ρ=0.742,0.884,0.805,0.886;均P<0.001)。血清CRP、血清D-D、脑脊液CRP、脑脊液D-D对诊断ICP>20 mmHg均有较可靠的价值,其曲线下面积分别为0.854,0.943,0.870,0.951。脑脊液D-D是ICP>20 mmHg的独立影响因素(OR=4.115,P=0.001)。结论:重度颅脑损伤开颅术后,患者早期ICP与脑脊液及外周血CRP,D-D均呈明显的正相关,且与脑脊液D-D的关系最密切。联合检测脑脊液及外周血CRP及D-D有助于反映患者ICP变化情况,从而对患者术后治疗提供参考。Objective: To investigate the correlation of early intracranial pressure with CRP and D-dimer (D-D) in cerebrospinal fluid and peripheral blood in patients with severe traumatic brain injury after craniotomy, and to provide reference for the judgment of severe craniocerebral injury disease. Methods: Thirtyseven patients with severe craniocerebral injury treated by craniotomy in the Department of Neurosurgery from January 2015 to December 2017 was involved. Postoperative ICP of all patients were detected by intracranial pressure catheter. The cerebrospinal fluid and peripheral blood samples of patients were collected at each 12 h within 3 days after surgery, CRP and D-D were detected, and the corresponding ICP index at the time point was statistically analyzed. Results: A total of 222 copies of the data were obtained, in which 105 copies showed ICP >20 mmHg and 117 showed ≤20 mmHg. When ICP >20 mmHg, CRP and D-D in both serum and cerebrospinal fluid were higher than when ICP ≤20 mmHg (P<0.05). ICP was positive correlated with CRP in serum, D-D in serum, CRP in cerebrospinal fluid and D-D in cerebrospinal fluid (ρ=0.742, 0.884, 0.805, 0.886;all P<0.001). CRP in serum, D-D in serum, CRP in cerebrospinal fluid and D-D in cerebrospinal fluid were all reliable values for the diagnosis of ICP >20 mmHg. The area under ROC were 0.854, 0.943, 0.870, and 0.951, respectively. D-D in cerebrospinal fluid was an independent factor of ICP >20 mmHg (OR=4.115, P=0.001). Conclusion: The early postoperative ICP has positive correlation with serum and peripheral blood CRP and D-D in both cerebrospinal fluid and peripheral blood, and it is most closely related to CSF D-D. The combined detection of CRP and D-D in cerebrospinal fluid and peripheral blood can help to reflect the change of ICP in patients, so as to provide reference for postoperative treatment.

关 键 词：颅脑损伤 颅内压 外周血 脑脊液 C反应蛋白 D-二聚体 

分 类 号：R651.15[医药卫生—外科学]