颅内压监护在额叶脑挫裂伤中应用的临床体会

Clinical Application of Continuous Monitoring of ICP to Prognosis of Severe Brain Injury

目的分析额叶脑挫裂伤患者施行颅内压(intracranial pressure,ICP)监测对临床诊治的意义。方法 2007年10月至2010年5月,对48例额叶脑挫裂伤患者,采用穿刺置管法行脑室额角或附近ICP监护,使用美国强生-REF-8266型监护仪进行4～9d连续监测;常规进行脱水、止血、亚低温等治疗,同时监测有创血压了解脑灌注压(cerebral perfusion pressure,CPP)结合头颅CT变化,及时调整治疗方案。结果在48例患者中有8例ICP<2.67Kpa,保守治疗愈后良好;ICP2.67～5.33Kpa的患者为27例;监护治疗中出现13例ICP>5.33Kpa或ICP进行性增高,再行CT检查发现迟发性颅内血肿或脑挫伤病灶明显增大等行手术治疗,有20例愈后良好,5例中重残,2例死亡。持续性ICP≥5.33Kpa的患者13例全部急诊手术,有6例愈后较良好,5例重残,2例死亡。结论 ICP动态监测有助于准确判断病情变化,ICP亦能较准确反映脑灌注压(CPP),对额叶脑挫裂伤患者应放宽手术适应证,尽早手术可降低死亡率及残障率。

Objective Continuous monitoring of intracranial pressure （ICP） was performed in 48 patients with severe brain injury. Methods From 2007 to 2010,48 patients undergoing continuous montoring obtained the treatment and nursing in terms of ordinary clinical observation were reviewed retrospectively. According to the monitoring results,corresponding treatment and nursing care were given timely.Results Among them,8 patients with ICP2.67Kpa had a good prognosis and 13 patients with ICP≥5.33Kpa had performed operation. The ICP and CPP measurements demonstrated that the patients with ICP2.67Kpa and CPP10.6Kpa had a good prognosis,the results showed that the patients with complications,disability rate as well as mortality were decreased obviously. The operation was performed successfully in the 28 patients.While the patients with ICP≥5.33Kpa and CPP6.67Kpa had a worse prognosis.Conclusion It was suggested that continuous ICP monitoring for the patients with servere brain injury was of great clinical value for knowing the diseased conditions,carrying out effective treatment and reducing the disability rate as well as mortality rate.