持续颅内压及脑组织氧分压监测在重度颅脑损伤患者标准大骨瓣减压术及显微血肿清除术后的应用  

Continuous monitoring of intracranial pressure and partial oxygen pressure of brain tissue in patients with severe traumatic brain injury after standard decompressive craniectomy and microscopic hematoma removal

作　　者：王忠 张瑞剑 韩志桐 张晓军 包金岗 张义松 赵卫平 杨蔚然 张之龙 Wang Zhong;Zhang Ruijian;Han Zhitong;Zhang Xiaojun;Bao Jingang;Zhang Yisong;Zhao Weiping;Yang Weiran;Zhang Zhilong(Department of Neurosurgery,Inner Mongolia People's Hospital,Hohhot 010017,China)

机构地区：[1]内蒙古自治区人民医院神经外科,呼和浩特010017

出　　处：《中国综合临床》2022年第1期68-73,共6页Clinical Medicine of China

基　　金：内蒙古自治区关键技术攻关计划项目(2019GG051);内蒙古自治区卫生与健康委员会资助项目(201701009);内蒙古自治区科技厅资助项目(201502107,20120401)。

摘　　要：目的探讨持续颅内压及脑组织氧分压(brain tissue oxygen partial pressure,PbtO_(2))监测在重型颅脑损伤患者标准大骨瓣减压术及显微血肿清除术后的应用及对预后的影响。方法纳入内蒙古自治区人民医院神经外科2018年1月至2020年5月收治的41例重度颅脑损伤患者的临床资料,对其进行回顾性病例对照研究。格拉斯哥昏迷评分(Glasgow coma score,GCS)<8分的患者,行显微镜下血肿及挫伤脑组织清除术及标准大骨瓣减压术。术中置入颅内压及脑组织氧分压监测探头,术后给予持续颅内压监测及脑组织氧分压监测,并在监测下给予目标导向治疗。根据6个月后格拉斯哥预后(Glasgow outcome score,GOS)评分,分为预后良好(4~5分)组26例和预后不良(1~3分)组15例。采用一般线性双变量Pearson相关性分析颅内压及PbtO_(2)与GOS评分之间的关系,并采用线性回归分析进一步评价颅内压及PbtO_(2)与GOS评分之间的关系。正态分布的计量资料两组间比较采用独立样本t检验。计数资料以例(%)表示,组间比较采用χ^(2)检验。相关性采用一般线性双变量Pearson相关性检验。结果预后不良组PbtO_(2)(17.42±5.34)mmHg(1 mmHg=0.133 kPa)低于预后良好组(24.65±5.61)mmHg,差异有统计学意义(t=4.04,P<0.001);预后不良组颅内压(22.32±3.45)mmHg高于预后良好组(17.32±3.23)mmHg,差异有统计学意义(t=4.15,P<0.001)。以颅内压及PbtO_(2)为自变量、6个月后GOS评分为因变量,建立回归方程(Y=4.040X+7.497;Y=-2.549X+28.63),PbtO_(2)与重型颅脑损伤患者6个月后GOS预后评分呈正相关(r=0.75,P<0.001),颅内压与重型颅脑损伤患者预后评分呈负相关(r=-0.87,P<0.001)。结论颅内压联合PbtO_(2)监测指导下的治疗对改善重度颅脑损伤患者术后的预后有应用价值,可能改善患者伤后6个月的预后。Objective To investigate the effect of continuous intracranial pressure(ICP)and brain oxygen partial pressure(PbtO_(2))monitoring and guiding treatment after the application of standard large bone flap decompression and microhematoma removal in patients with severe traumatic brain injury(TBI).Methods A retrospective analysis was done of 41 patients with TBI in Department of Neurosurgery in the Inner Mongolia People's Hospital from January 2018 to May 2020.Patients with Glasgow coma scale(GCS)<8 points were treatesd with microscopical removal of hematoma and contusion brain tissue and standard large bone flap decompression.Intraoperative intracranial pressure and brain tissue oxygen partial pressure monitoring probes were placed.Postoperatively,continuous intracranial pressure monitoring and partial oxygen pressure monitoring of brain tissue were performed,and target-based treatment under ICP and PbtO_(2) monitoring was performed.According to the Glasgow Outcome(GOS)score after six months,patients were divided into a good outcome group(4-5 scores)and a poor outcome group(1-3 scores).There were 26 cases in good prognosis group and 15 cases in poor prognosis group.Linear regression analysis was used to further evaluate the relationship between PbtO_(2),ICP and GOS score.The measurement data of normal distribution were compared by independent sample t-test.The counting data were expressed in cases(%),and the comparison between groups was adoptedχ^(2) inspection.The general linear bivariate Pearson correlation test was used.Results The mean value of PbtO_(2)(17.42±5.34)mmHg in the poor prognosis group was lower than that in the good prognosis group(24.65±5.61)mmHg,with statistical significance(t=4.04,P<0.001).The mean value of ICP(22.32±3.45)mmHg in the poor prognosis group was higher than that(17.32±3.23)mmHg in the good prognosis group,with statistical significance(t=4.15,P<0.001).Using PbtO_(2) and ICP as independent variables and GOS score after 6 months as dependent variable,a regression equation was establi

关 键 词：重度颅脑损伤 颅内压 脑组织氧分压 标准大骨瓣减压术 格拉斯哥预后评分 

分 类 号：R651.15[医药卫生—外科学]