不同类型颅内压监测下梯度减压术在重型颅脑损伤并脑疝患者中的应用对比研究  

Comparative study of gradient decompression under different types of intracranial pressure monitoring in patients with severe craniocerebral injury and cerebral herniation

作　　者：邓任强 郭智霖[2] 梁定兴 吴运桥 DENG Renqiang;GUO Zhilin;LIANG Dingxing;WU Yunqiao(Department of Neurosurgery,Hainan Western Central Hospital,Danzhou 571700,China)

机构地区：[1]海南西部中心医院神经外科,儋州571700 [2]上海交通大学医学院附属第九人民医院神经外科

出　　处：《临床神经外科杂志》2024年第6期668-672,共5页Journal of Clinical Neurosurgery

基　　金：海南省卫生健康行业科研项目(21A200376)。

摘　　要：目的 探讨脑室型颅内压(ICP)监测与单纯型ICP监测下梯度减压术在重型颅脑损伤(sTBI)并脑疝患者中的应用效果。方法 选取海南西部中心医院神经外科2021年6月-2023年6月收治的86例sTBI并脑疝患者为研究对象,随机数字表法分为A组(n=43)、B组(n=43)。比较两组围术期并发症、甘露醇应用剂量及时间、近期疗效、远期疗效、术后并发症。结果 A组急性恶性脑膨出、迟发性血肿发生率低于B组(P<0.05);A组甘露醇应用剂量低于B组,应用时间短于B组(P<0.05);A组术后24 h瞳孔恢复率低于B组,格拉斯哥昏迷指数(GCS)评分高于B组(P<0.05);两组远期疗效无显著差异(P>0.05);两组术后并发症发生率无显著差异(P>0.05)。结论 相较于单纯型ICP监测,脑室型ICP监测下梯度减压术应用于sTBI并脑疝患者,可降低急性恶性脑膨出、迟发性血肿发生率,优化甘露醇使用情况,改善近期预后,且未增加术后并发症。Objective To investigate the effect of gradient decompression under ventricular intracranial pressure(ICP)monitoring and simple ICP monitoring in patients with severe traumatic brain injury(sTBI)and cerebral herniation.Methods Eighty-six patients with sTBI and cerebral herniation admitted to the Department of Neurosurgery,Hainan Western Central Hospital from June 2021 to June 2023 were selected as the research subjects,and were divided into group A(n=43)and group B(n=43)by random number table method.Perioperative complications,dose and time of mannitol,short-term efficacy,long-term efficacy and postoperative complications were compared between the two groups.Results The incidence of acute malignant encephalocele and delayed hematoma in group A was lower than that in group B(P<0.05).The applied dose of mannitol in group A was lower than that in group B,and the applied time was shorter than that in group B(P<0.05).Postoperative 24 h pupil recovery rate in group A was lower than that in group B,and Glasgow coma scale(GCS)score was higher than that in group B(P<0.05).There was no significant difference in long-term efficacy between the two groups(P>0.05).The incidence of postoperative complications was not significantly different between the two groups(P>0.05).Conclusions Compared with simple ICP monitoring,gradient decompression under ventricular ICP monitoring in sTBI patients with cerebral herniation can reduce the incidence of acute malignant encephalocele and delayed hematoma,optimize the use of mannitol,improve the short-term prognosis,and do not increase postoperative complications.

关 键 词：脑室型 单纯型 颅内压监测 梯度减压术 重型颅脑损伤 脑疝 

分 类 号：R651[医药卫生—外科学]