脑室内颅内压持续监测和阶梯式治疗重型颅脑外伤

Stepwise management of severe traumatic brain injured patients guided by ICP monitoring

目的探讨脑室内颅内压持续监测对重型颅脑损伤后颅内压增高治疗的指导意义及阶梯式干预治疗的效果。方法对上海市神经外科急救中心2004年11月至2006年1月间收治128例重型颅脑损伤患者,其中GCS 3～5分55例,6～8分73例全部行脑室内颅内压监测术,116例行Codman脑室探头置入颅内压监测术,12例行Camino脑室探头颅内压监测术。根据颅内压变化予以相应的阶梯式治疗,以达到理想的颅内压控制及维持脑灌注压。结果预后良好72例(56.3%);中残12例(9.4%);重残23例(18.0%);植物状态10例(7.8%);死亡11例(8.6%)。结论脑室内颅内压监测下通过阶梯式治疗能有效控制颅内压,维持脑灌注压,降低重型颅脑外伤的病残率和死亡率。

Objective To elucidate the effectiveness of stepwise management of elevated intracranial pressure guided by ICP monitoring for severe traumatic brain injured （TBI） patients. Methods 128 patients with severe TBI, GCS score 3 - 5 in 55 cases and GCS score 6 - 8 in 73 cases, admitted at Shanghai Neurosurgical Emergency Center from Nov. 2004 to Jan. 2006 were evaluated prospectively. A ventrieulostomy catheter was implanted routinely and intraeranial pressure was measured continuously for 4 9 days. A staircase intraeranial pressure control algorithm for controlling intraeranial pressure and maintaining cerebral perfusion pressure was adopted. Results According to GOS for assessment of outcome, 72 cases （56.3%） survived with good recovery, 12 cases （9.4%） with moderate disability, 23 cases （18.0%） with severe disability, 10 cases （7.8%） with vegetative status and 11 cases （8.6%） died. Conclusions Intraventrieular ICP monitoring has played an important role in the management of severe traumatic brain injured patients. Stepwise management of elevated intraeranial pressure can effectively assist in controlling intracranial pressure, maintaining cerebral perfusion pressure and decreasing the disability rate and mortality.