多模态脑监测系统在重症脑损伤患者治疗中的价值  

Value of multimodal brain monitoring system to the treatment of severe brain injury

作　　者：孙瑞迅 李琳坤 刘飒 陈洋 刘保洋 SUN Ruixun;LI Linkun;LIU Sa;CHEN Yang;LIU Baoyang(ICU of Department of Neurosurgery,the Second People's Hospital of Nanyang,Nanyang,Henan 473300,China)

机构地区：[1]南阳市第二人民医院神经外科ICU,河南南阳473300

出　　处：《中华实用诊断与治疗杂志》2023年第7期743-746,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关联合共建项目(2018020983)。

摘　　要：目的 探讨重症脑损伤患者治疗期间应用多模态脑监测系统监测颅内压、脑血流动力学及脑电生理学变化对及时控制颅高压、减轻脑损伤、促进神经功能恢复的作用。方法 2019年1月—2021年1月南阳市第二人民医院诊治重症脑损伤患者112例,治疗期间行多模态脑监测者56例为观察组,未行多模态脑监测者56例为对照组。观察组患者颅内植入颅内压探头监测颅内压、经颅多普勒超声监测脑血流动力学、视频脑电图记录脑电变化;对照组采用常规颅脑CT及观察瞳孔、引流管液平面评估颅内压。2组治疗期间均采用床头抬高30°~45°、亚低温、镇痛镇静、机械通气、渗透脱水、脑脊液引流、手术减压等方法控制颅压,均以颅内压<20 mmHg为治疗目标。比较2组性别、年龄、入院时格拉斯哥昏迷评分(GCS),合并高血压、糖尿病、心功能不全及呼吸机辅助通气比率等临床资料;采用GCS评估2组治疗第7天脑损伤及意识恢复情况;采用格拉斯哥结局评分(GOS)评估2组出院3个月时神经功能恢复情况;比较2组住院时间及治疗期间癫痫、颅内感染、肺部感染发生率。结果 2组男性、高血压、糖尿病、心功能不全、癫痫、开颅手术、肺部感染、颅内感染、呼吸机辅助通气比率及年龄、入院时GCS评分比较差异均无统计学意义(P>0.05)。观察组住院时间[(26.00±4.58)d]短于对照组[(27.00±5.26)d](t=1.253,P=0.031),治疗第7天GCS评分[(7.60±3.23)分]、出院3个月GOS评分[(3.48±1.26)分]均高于对照组[(6.32±2.39)、(3.11±1.06)分](t=2.392,P=0.039;t=1.703,P=0.042),治疗期间癫痫、颅内感染及肺部感染发生率与对照组比较差异均无统计学意义(P>0.05)。结论 重症脑损伤患者治疗期间行多模态脑监测可实时监测颅内压、脑血流动力学、脑电生理学变化,有利于及时控制颅内压,减轻脑损伤、促进神经功能恢复,不增加并发症发生率。Objective To explore the role of multimodal brain monitoring(MMM) system in controlling intracranial pressure,alleviating brain injury and promoting the recovery of neurological function by monitoring intracranial pressure,cerebral hemodynamic and electroencephalographic changes during the treatment of severe brain injury.Methods Totally 112 patients with severe brain injury were diagnosed and treated in the Second People's Hospital of Nanyang from January 2019 to January 2021,among whom 56 received MMM during treatment(observation group) and the other 56 received no MMM(control group).In observation group,an intracranial pressure probe was implanted intracranially to detect the intracranial pressure,transcranial Doppler was used to monitor the cerebral hemodynamic indexes and video-electroencephalography was done to record the electroencephalogram changes.In control group,the intracranial pressure was assessed by using conventional brain CT,and observing pupils and drainage tube fluid levels.The intracranial pressure was controlled by bed head elevation to 30° to 45°,subhypothermia,analgesia and sedation,mechanical ventilation,osmotic dehydration,cerebrospinal fluid drainage and surgical decompression.The intracranial pressure 20 mmHg was set as the therapeutic target value in two groups.The clinical data were compared between two groups including the gender,age,admission Glasgow coma scale(GCS),and percentages of hypertension,diabetes,heart dysfunction and mechanical ventilation.GCS was scored to evaluate the brain injury and recovery of consciousness in two groups by day 7 after treatment.The Glasgow outcome scale(GOS) was scored to assess the neurological function recovery at 3 months after discharge.The length of hospital stay,and the incidences of seizures,intracranial infection and pulmonary infection during treatment were compared between two groups.Results There were no significant differences in the percentages of males,hypertension,diabetes,heart dysfunction,seizures,craniotomy,pulmonary infection,in

关 键 词：重症脑损伤 多模态脑监测 颅内压监测 经颅多普勒超声 视频脑电图 

分 类 号：R651.15[医药卫生—外科学]