重型颅脑损伤术后有创颅内压监测的临床应用

Clinical application of invasive intracranial pressure monitoring after severe traumatic brain injury

目的比较重型颅脑损伤术后不同的有创颅内压(ICP)监测方式对患者预后的影响,明确各种颅内压监测方式对重型颅脑损伤临床救治的意义。方法收集2009年1月-2010年6月接受手术治疗的201例重型颅脑损伤(STBI)病例,根据ICP探头的位置和放置方法分为A、B、C三组(每组67例),在常规手术的基础上分别于脑室、脑实质或硬膜下放置ICP监测探头。术后3～7d行腰穿,1次/d,记录脑脊液压力值及同时刻ICP监测仪显示的ICP值,计算两值之差并行组间比较。术后根据ICP值进行相应的脱水治疗,统计脱水剂使用的时间、剂量,手术操作时间,各种并发症发生率及患者预后,并进行组间比较。结果 A、B、C三组ICP监测值与脑脊液压力值的差值分别为22.4±3.6、20.8±4.1和12.3±11.5mmH2O。与A、B组比较,C组甘露醇使用时间和剂量显著增加(P<0.01),肺部感染和电解质紊乱的发生率显著升高(P<0.01),但三组患者的总体预后无显著差异。A组的手术操作时间显著长于B、C组(P<0.01),而B、C组手术时间无显著差异。结论持续有创颅内压监测所得ICP值较为稳定,是重型颅脑损伤救治的重要手段;脑实质内放置探头是较为有效的监测方式。

Objective The current study aims to investigate the effects of different intracranial pressure（ICP） monitoring means on the prognosis of severe traumatic brain injury,and to determine the significance of all kinds of intracranial pressure monitoring methods for treating severe traumatic brain injury clinically.Methods From January 2009 to June 2010,a total of 201 cases of severe traumatic brain injury（STBI） who received operation treatment were collected and divided into A,B,and C groups based on the positions of the ICP probes and the placement methods.ICP monitoring probes were placed in the ventricle of the brain,parenchyma,or under the putamen,on the basis of the routine operation.Lumbar puncture was done once a day for three to seven days after operation.The Ncurolymph pressure and ICP value that are simultaneously shown in the ICP monitoring device were recorded to calculate the difference between them and to conduct comparison among the groups.The corresponding dehydration treatment was made based on the ICP value after operation to record the duration of use and dosage of the dehydrating agent,operation time,occurrence of all kinds of complications,and the prognosis of patients,and to create a comparison among the groups.Results The different values between the ICP monitoring values and ncurolymph pressure in the A,B,and C groups were 22.4±3.6,20.8±4.1,and 12.3±11.5 mmH2O,respectively. The dosage and durationof use of mannitol in group C were significantly higher than those in groups A and B（P0.01）,whereas the incidence of pulmonary infection and electrolyte disturbance in group C was higher than those in groups A and B（P0.01）.However,no significant difference of prognosis was observed among the three groups.The operating duration of group A was significantly longer than those of groups B and C（P0.01）.However,the overall prognosis of the patients in the three groups had no significant difference.The operation time of group A was longer than that of groups B and C（P0.01）,whereas the operation time of groups B and C had no significant difference.Conclusion The ICP value obtained through continuous invasive ICP monitoring is more stable,which makes it an important means for treating STBI.In addition,placing probes in the parenchyma is an effective monitoring method.