颅内压监测阶梯治疗方案治疗继发严重外伤性脑水肿

A protocol of stepwise therapy for patients after TBI under ICP monitoring

目的探讨颅内压监测下的阶梯治疗方案对于严重外伤性脑水肿的治疗有效性。方法24例入院评分GCS14或15分的轻度颅脑损伤患者继发严重脑水肿，经有创颅内压监测，阶梯治疗方案有效控制高颅压，缓解脑水肿。结果颅内压监测下的阶梯治疗安全有效地治疗此病例组的脑水肿和高颅压，其中14例手术清除血肿去骨瓣减压，10例仅阶梯治疗就良好控制颅内压，所有病例组无死亡和严重并发症，3个月后随访所有病例GOS评分均为5分。结论颅内压监测下阶梯治疗方案在控制轻度颅脑损伤患者继发严重脑水肿是有效的；颅内压是此类患者治疗重要的监测标准。

Objective To verify the step - wise therapy under ICP monitoring is effective on severe brain edema after TBI. Methods 24 cases with mild TBI with GCS score 14 or 15 had severe brain edema. All these edema cases had been controlled under stepwise therapy and intensive ICP monitoring. Results 14 of 24 cases with severe edema underwent decompression and 10 of which without. All cases recovered smoothly and had no mortality and morbidity, or even severe complication. All the patients＇GOS scores after 3 months were 5. Conclusions The step - wise therapy under ICP monitoring is effective and safe for severe edema of mild TBI patients. ICP is the most important standard for mild edema after TBI.