脑室型ICP监测下阶梯性减压在重型颅脑损伤患者中的应用分析  

Application of Stepwise Decompression under Ventricular ICP Detection on Patients with Severe Craniocerebral Injury

作　　者：杨幸达 胡友珠 邹志斌 钟波 邹国荣 罗庆勇 熊志强 YANG Xingda;HU Youzhu;ZOU Zhibin;ZHONG Bo;ZOU Guorong;LUO Qingyong;XIONG Zhiqiang(Xinyu City People’s Hospital,Jiangxi Province,Xinyu 338000,China;不详)

机构地区：[1]江西省新余市人民医院,江西新余338000

出　　处：《中国医学创新》2022年第22期5-9,共5页Medical Innovation of China

基　　金：江西省卫生健康委科技计划项目(SKJP220210002)。

摘　　要：目的:分析脑室型颅内压(ICP)监测下阶梯性减压技术治疗重型颅脑损伤患者的效果。方法:对新余市人民医院神经外科2020年1月-2021年7月收治的70例重型颅脑损伤患者资料进行回顾性分析,根据术式不同将患者分为对照组(n=38,采用传统开颅手术)和观察组(n=32,采用脑室型ICP监测联合阶梯性减压技术),比较两组围术期指标[手术时间、格拉斯哥昏迷评分(GCS)、瞳孔变化、美国国立卫生研究院卒中量表(NIHSS)评分、二次手术率],不同时间(术后1、3、7 d)脑灌注压和颅内压变化,术后并发症发生率及术后6个月格拉斯哥预后评分(GOS)。结果:两组患者术后GCS评分较术前升高,术后NIHSS评分较术前降低(P<0.05),观察组术后GCS评分、NIHSS评分优于对照组(P<0.05);观察组瞳孔变化情况优于对照组,二次手术率低于对照组(P<0.05),两组手术时间比较,差异无统计学意义(P>0.05);术后对照组和观察组患者脑灌注压均随时间延长而显著升高(P<0.05),术后1、3、7 d,观察组脑灌注压均高于对照组(P<0.05);术后对照组和观察组患者ICP均随时间延长而显著降低(P<0.05),术后1、3、7 d,观察组ICP均低于对照组(P<0.05);观察组弥漫性脑肿胀、急性脑膨出、迟发性血肿的发生率低于对照组(P<0.05),两组术后脑梗死发生率比较,差异无统计学意义(P>0.05);术后6个月,观察组死亡2例(6.25%),对照组死亡6例(15.79%),两组死亡率比较,差异无统计学意义(P>0.05),观察组术后6个月GOS评分分布优于对照组,差异有统计学意义(P<0.05)。结论:脑室型ICP监测下阶梯性减压技术能够改善重型颅脑损伤患者围术期指标,减少并发症发生率,增加脑灌注,改善神经功能和预后,值得临床推广。Objective:To analyze the effects of stepwise decompression technique under ventricular intracranial pressure (ICP) monitoring in the treatment of patients with severe craniocerebral injury.Method:The data of 70 patients with severe craniocerebral injury treated in Department of Neurosurgery of Xinyu City People’s Hospital were retrospectively analyzed from January 2020 to July 2021.According to different surgical methods,the patients were divided into the control group (n=38,traditional craniotomy) and the observation group (n=32,stepwise decompression technique under ventricular ICP monitoring).The perioperative indicators[surgical time,Glasgow coma scale (GCS),pupil changes,postoperative National Institute of Health stroke scale (NIHSS) score,secondary surgery rate],cerebral perfusion pressure and intracranial pressure changes at different time points (1,3 and 7 d after surgery),incidence rates of postoperative complications and Glasgow outcome scale (GOS) at 6 months after surgery were compared between the two groups.Result:The postoperative GCS scores in the two groups were improved,the postoperative NIHSS scores were reduced (P0.05).The cerebral perfusion pressure in the control group and the observation group after surgery were increased significantly with time (P0.05).At 6 months after surgery,2 cases (6.25%) died in the observation group and 6 cases (15.79%) in the control group,and the difference in the mortality rate between the two groups was no statistically significant (P>0.05).The GOS score distribution in the observation group at 6 months after surgery was significantly better than that in the control group (P<0.05).Conclusion:Stepwise decompression technique under ventricular ICP monitoring can improve the perioperative indicators,reduce the incidence rates of complications,increase the cerebral perfusion,and improve the neurological function and prognosis in patients with severe craniocerebral injury,therefore it is worthy of clinical promotion.

关 键 词：重型颅脑损伤 脑室型颅内压监测 阶梯性减压技术 并发症 预后 

分 类 号：R651.15[医药卫生—外科学]