重型颅脑损伤后颅内压、脑温和直肠温度的监测及意义  

Monitoring and Significance of Intracranial Pressure, Brain Temperature and Rectal Temperature after Severe Head Injury

作　　者：金科 褚荣涛[2] 孙成法[2] 张志越[2] 程序曲[2] 施振华[2] 支文勇[2] 赵富文[2] JIN Ke;CHU Rong-tao;SUN Cheng-fa;ZHANG Zhi-yue;CHENG Xu-qu;SHI Zhen-hua;ZHI Wen-yong;ZHAO Fu-wen(Department of Neurosurgery,Taicang City Hospital of Traditional Chinese Medicine,Taicang,Jiangsu Province,215400 China;Department of Neurosurgery,Second People's Hospital of Changshu,Changshu,Jiangsu Province,215500 China)

机构地区：[1]江苏省太仓市中医医院神经外科,江苏太仓215400 [2]江苏省常熟市第二人民医院神经外科,江苏常熟215500

出　　处：《中外医疗》2019年第31期25-27,共3页China & Foreign Medical Treatment

摘　　要：目的探讨重型颅脑损伤后颅内压(ICP)、脑温(BT)以及直肠温度(RT)的变化规律及意义。方法方便选择该院2015年8月-2018年11月间收治的31例重型颅脑损伤患者作为实验对象;对31例重型颅脑损伤患者(27例手术治疗,4例保守治疗)进行连续的ICP、BT、RT监测,并分析之间的关系。结果 3个月后随访:预后良好7例(22.6%),5例中残(16.1%),8例重残(25.8%),5例植物生存(16.1%),6例死亡(19.4%)。死亡病例的BT、RT持续降低,BT0.05)。BT>RT,RT同BT之间表现为正相关(r=0.647,P<0.05)。手术病例的ICP在术后缓解,以后逐步增高,后逐步恢复正常。保守病例的ICP逐步增高,后逐渐恢复正常。RT与BT的差值,伴随着ICP的逐渐增高,死亡组中呈逐步增加;重残组、植物生存组中呈逐步减小,随着ICP逐步正常而逐步增加。而良好组以及中残组中差值未表现出此种变化。在存活组中,将ICP以≤20 mmHg,20~30 mmHg,30~40 mmHg,≥40 mmHg分为4组,BT和RT的差值分别为:(1.1±0.5)℃,(0.7±0.3)℃,(0.5±0.3)℃,(0.2±0.1)℃,各组间差异有统计学意义(P<0.05)。结论 BT、RT与ICP无明显联系。BT与RT存在联系,但不能简单地以RT替代BT。监测BT、ICP对预后评估及临床治疗有重要价值。Objective To investigate the changes and significance of intracranial pressure(ICP), brain temperature(BT) and rectal temperature(RT) after severe craniocerebral injury. Methods A total of 31 patients with severe craniocerebral injury from August 2015 to November 2018 were convenient selected as subjects. 31 patients with severe craniocerebral injury(27 surgical treatments and 4 conservative treatments) underwent continuous ICP and BT, RT monitoring, and analysis of the relationship therebetween. Results Follow-up after 3 months: good prognosis in 7 patients(22.6%), 5 patients with disability(16.1%), 8 patients with severe disability(25.8%), 5 plants survival(16.1%), and 6 deaths(19.4%). The BT and RT of the death cases continued to decrease, BT0.05). BT>RT, RT and BT showed a positive correlation(r=0.64,P<0.05). The ICP of the surgical case was relieved after the operation, and gradually increased gradually, and then gradually returned to normal. The ICP of conservative cases gradually increased, and then gradually returned to normal. The difference between RT and BT, accompanied by the gradual increase of ICP, gradually increased in the death group;the weight loss group and the plant survival group gradually decreased, and gradually increased with the ICP gradually normal. The difference between the good group and the middle group did not show such a change. In the survival group, ICP was divided into 4 groups with ≤20 mmHg, 20 ~30 mmHg, 30 ~40 mmHg, ≥40 mmHg. The difference between BT and RT was:(1.1±0.5)℃,(0.7±0.3)℃,(0.5±0.3)℃ and(0.2±0.1)℃. There was a statistically significant difference(P<0.05) between the groups. Conclusion There is no obvious relationship between BT, RT and ICP. BT has a connection with RT, but it cannot simply replace BT with RT. Monitoring BT and ICP is of great value for prognosis assessment and clinical treatment.

关 键 词：重型颅脑损伤 颅内压 脑温 直肠温度 预后 

分 类 号：R651[医药卫生—外科学]