脑电双频指数镇痛镇静联合液压耦合颅内压监测在重型颅脑损伤中的应用研究  

Application of analgesia and sedation under BIS monitoring combined with hydraulic coupling intracranial pressure monitoring in severe craniocerebral injury

作　　者：蔡勇[1] 董朝晖[2] 钟兴明[1] 汪一棋[1] 阳建国[1] 赵朝辉[1] 费振海 张磊[1] 顾华[1] 杨涛[1] Cai Yong;Dong Zhaohui;Zhong Xingming;Wang Yiqi;Yang Jianguo;Zhao Chaohui;Fei Zhenhai;Zhang Lei;Gu Hua;Yang Tao(Department of Neurosurgery,the First Affiliated Hospital of Huzhou Normal College,Huzhou 313000,Zhejiang,China;Department of Critical Care Medicine,the First People's Hospital of Huzhou First Affiliated Hospital of Huzhou Normal College,Huzhou 313000,Zhejiang,China)

机构地区：[1]湖州市第一人民医院、湖州师范学院附属第一医院神经外科,浙江湖州313000 [2]湖州市第一人民医院、湖州师范学院附属第一医院重症医学科,浙江湖州313000

出　　处：《中华危重病急救医学》2023年第12期1274-1280,共7页Chinese Critical Care Medicine

基　　金：浙江省湖州市科技局公益性应用研究项目(2020GY12)。

摘　　要：目的探讨脑电双频指数(BIS)镇痛镇静联合液压耦合颅内压(ICP)监测在重型颅脑损伤(sTBI)中的临床应用价值。方法①采用前瞻性自身平行对照研究方法,选择2020年12月至2021年7月湖州市第一人民医院重症监护病房(ICU)收治的32例sTBI开颅术后患者作为研究对象,同时应用Codman监测系统和液压耦合监测系统监测ICP值,比较两者的差异及相关性。②采用前瞻性随机对照研究方法,选择2021年8月至2022年8月湖州市第一人民医院ICU收治的108例sTBI开颅术后患者,按随机数字表法分为3组,所有患者均予脑外科术后诊疗常规,并在此基础上,A组(35例)辅以Codman监测系统监测ICP值,B组(40例)辅以液压耦合监测系统监测ICP值,C组(33例)通过BIS指导镇痛镇静并联合液压耦合监测系统监测ICP值。比较3组患者治疗后ICP、脑脊液引流时间、ICP监测时间、ICU住院时间、并发症发生情况以及术后6个月格拉斯哥预后评分(GOS)等指标。此外,对于B组和C组患者根据波形进行再次分组,若P_(1)=P_(2)或P_(2)、P_(3)低则为代偿组;若圆形波或P_(2)>P_(1)则为失代偿组,比较两组患者术后6个月GOS评分。结果①同一患者分别采用Codman监测系统与液压耦合监测系统测得的ICP值差异无统计学意义(mmHg:11.94±1.76比11.88±1.90,t=0.150,P=0.882;1 mmHg≈0.133 kPa),Bland-Altman分析显示,两种方法测量ICP值95%一致性界限(95%LoA)为-4.55~4.68 mmHg,且所有的点均落在95%LoA内,表明两种测量方法具有良好的相关性。②3组sTBI患者脑脊液引流时间、ICP监测时间、ICU住院时间以及颅内感染、颅内再出血、外伤型脑积水、脑脊液漏、意外拔管等并发症发生率差异均无统计学意义(P>0.05或P>0.017)。C组治疗后ICP值显著低于A组和B组(mmHg:20.94±2.37比25.86±3.15、26.40±3.09,均P<0.05),肺部感染发生率(9.1%比45.7%、42.5%)、癫痫发作发生率(3.0%比31.4%、30.0%)、再次手术率(3.0%比31.4%�Objective To investigate the clinical value of analgesia and sedation under bispectral index(BIS)monitoring combined with hydraulic coupled intracranial pressure(ICP)monitoring in severe craniocerebral injury(sTBI).Methods①A prospective self-controlled parallel control study was conducted.A total of 32 patients with sTBI after craniotomy admitted to the intensive care unit(ICU)of the First People's Hospital of Huzhou from December 2020 to July 2021 were selected as the research objects.ICP was monitored by Codman monitoring system and hydraulically coupled monitoring system,and the difference and correlation between them were compared.②A prospective randomized controlled study was conducted.A total of 108 sTBI patients admitted to the ICU of the First People's Hospital of Huzhou from August 2021 to August 2022 were selected patients were divided into 3 groups according to the random number table method.All patients were given routine treatment after brain surgery.On this basis,the ICP values of the patients in group A(35 cases)were monitored by Codman monitoring system,the ICP values of the patients in group B(40 cases)were monitored by hydraulic coupling monitoring system,and the ICP values of the patients in group C(33 cases)were monitored combined with hydraulic coupling monitoring system,and the analgesia and sedation were guided by BIS.The ICP after treatment,cerebrospinal fluid drainage time,ICP monitoring time,ICU stay time,complications and Glasgow outcome score(GOS)at 6 months after surgery were compared among the 3 groups.In addition,patients in group B and group C were further grouped according to the waveforms.If P_(1)=P_(2)wave or P_(2)and P_(3)wave were low,they were classified as compensatory group.If the round wave or P_(2)>P_(1)wave was defined as decompensated group,the GOS scores of the two groups at 6 months after operation were compared.Results①There was no significant difference in ICP values measured by Codman monitoring system and hydraulic coupling monitoring system in the same pati

关 键 词：重型颅脑外伤 颅内压 脑电双频指数 监测 液压耦合 

分 类 号：R651.15[医药卫生—外科学]