重型颅脑损伤持续颅内压及脑灌注压监护与预后关系

Relation of continuous ICP,CPP monitoring with prognosis for severe brain injury

作者对５０例重型颅脑损伤患者（ＧＣＳ３－８分），及５０例伤情与诊断和手术方式基本相似的另一组患者进行颅内压（ＩＣＰ）与脑灌注压（ＣＣＰ）连续监测对比研究。结果表明，监护组除８例ＩＣＰ压力＜２．００ｋＰａ，ＣＰＰ＞９．３３ｋＰａ外，余４２例均有不同程度ＩＣＰ增高与ＣＰＰ降低。这些患者分别为创伤性颅内血肿、广泛性脑挫裂伤、继发性脑水肿或脑肿胀等，均采取积极的手术及综合治疗。死亡率为１４％。非监护组治疗方法与监护组相同，预后较差且并发症多，死亡率为２８％。作者认为，对重型颅脑损伤患者施行连续ＩＣＰ、ＣＰＰ监护，是降低并发症和死亡率，提高疗效的有力措施，具有重要的临床应用价值。

We analysed the treatment results of two groups of patients. Group I included 50 patients with severe brain injury with GCS 3￣8, on whom continuous intracranial pressure (ICP) and cerebral perfusion pressure(CPP)monitoring was performed and Group Ⅱ included 50 cases of similar patients, on whom no continuous ICP monitoring was performed. In Group I 8 patients had normal ICP (<2 0 kPa),CPP(>9 33kpa),and the rest 42 had increased, ICP and reduced CPP. After adequate intervention including operation and drug treatment,group I patients had good results with a mortality of 14%.Group Ⅱ patients received the same intervention based on clinical observations, but they had relatively worse results.We are of the opinion that continuous ICP and CPP monitoring for severe brain injury patients helps find proper treatments and reduce mortality.