脑疝患者去骨瓣减压术后颅内压监测的价值研究  

Study on the application value of intracranial pressure monitoring in patients with cerebral hernia after decompressive craniectomy

作　　者：谢民[1] 李映霞 武志 郑茂华[1] XIE Min;LI Yingxia;WU Zhi;ZHENG Maohua(The First Hospital of Lanzhou University,,Lanzhou 730000,China)

机构地区：[1]兰州大学第一医院,甘肃兰州730000

出　　处：《中国实用神经疾病杂志》2021年第22期1955-1963,共9页Chinese Journal of Practical Nervous Diseases

基　　金：甘肃省科技厅-科技计划项目-创新基地和人才计划(编号:20JR10RA687)。

摘　　要：目的探讨脑疝患者开颅去骨瓣减压术后置入颅内压(ICP)监测的价值。方法对兰州大学第一医院神经外科2016-07—2020-06急诊脑疝患者进行回顾性队列研究,将置入ICP监测与未置入ICP监测的患者按比例1∶1进行倾向得分匹配(PSM)。主要结局指标是90 d的病死率,次要结局指标为住院病死率、颅内感染率、脱水治疗使用次数、90 d(mRS)评分、优秀结果(mRS评分0~1)、良好结果(mRS评分0~2)和住院时间。结果ICP监测组和无ICP监测组分别有90例和127例患者。PSM前ICP监测组有较高的90 d病死率(45.6%vs 32.3%,P=0.048)、住院病死率(23.3%vs 11.0%,P=0.017)、脱水药物的使用、更长的住院时间中位数(29 d vs 20 d,P=0.02),PSM后2组各有50例患者。ICP监测组和无ICP监测组90 d的病死率、住院病死率、颅内感染率及90 d(mRS)评分:优秀结果(评分0~1)、良好结果(评分0~2)和住院时间对比差异无统计学意义(P>0.05)。结论脑疝患者去骨瓣减压术后颅内压监测与未行颅内压监测患者预后无明显差异。Objective To explore the application value of ICP monitoring after craniotomy and decompression in patients with cerebral hernia.MethodsThe authors conducted a retrospective cohort study of all patients with brain herniation from July 1,2012 to June 31,2020,in the Neurosurgery Department of the First Hospital of Lanzhou University(LZU).Propensity score matching(PSM)was performed between ICP-monitored and non-ICP-monitored patients.The primary outcome measure was the 90-day mortality rate,and the secondary outcome measures included in-hospital mortality,intracranial infection rate,hypertonic usage and the modified Rankin Scores(mRS)at 90 days(a favorable outcome was defined as mRS 0-1 and a good outcome was defined as mRS 0-2)and length of hospital stay.Results A total of 90 ICP-monitored and 127 non-ICP-monitored patients were included.Before PSM matching,ICP-monitored patients had higher 90-day mortality(45.6%vs 32.3%,P=0.048)and in-hospital mortality(23.3%vs 11.0%,P=0.017),as well as a higher usage of dehydrating drugs and a longer hospital stay(29 days vs 20 days,P=0.02).Both groups consisted of 50 patients after PSM,and there was no significant difference(P>0.05)in the primary or secondary outcomes.Conclusion There was no significant difference(P>0.05)in prognosis between the conventional ICP monitoring group and the non-ICP monitoring group after DC.

关 键 词：脑疝 去骨瓣减压术 开颅术 颅内压监测 倾向得分匹配 预后 

分 类 号：R651.11[医药卫生—外科学]