重型颅脑损伤后颅内压监护的意义

Significance of Intracranial Pressure Monitoring after Severe Head Injury

探讨55例重型脑外伤病人的颅内压(ICP)水平的变化和意义。方法:全组病人均经侧脑室额角穿刺进行持续性脑室内压监护并记录,监护时间7小时到5天;监护后2小时的颅内压作为初压(入院压),分为ICP<2.67kPa和≥2.67kPa两组。持续监护中将ICP值分为3组:<2.67kPa,2.67～5.33kPa及>5.33kPa。结果:ICP≥2.67kPa者占71%,>5.33kPa者占16.5%。颅内血肿组ICP较脑挫伤组高(x^2=6.43,P<0.05),入院时ICP初压≥2.67kPa预后较差(x^2=7.65,P<0.05),持续监护中不同ICP之间预后差异有显著性(x^2=13.23,P<0.05)。同时证实ICP与GCS积分之间有相关关系。结论:持续ICP监护既能反映病人的病情演变和判断预后,又可较早发现颅内继发性损害,指导治疗。

To study changes of intracranial pressure (ICP) in 55 patients with severe head injury and their clinical significances. Methods:The frontal horn of lateral ventricle was punctured. The ICP was continuously monitored and recorded. The monitoring duration was 7 hours to 5 days. The ICP at 2 hours after monitoring was acted as an initial value (admission value).Based on < and ≥2.67 kPa,ICP values were classified into 2 groups.Based on <2.67 kPa,2.67~5.33 kPa and >5.33 kPa in continuously monitoring, ICP values were divided into 3 groups. Results: ICP was ≥2.67 kPa in 71% of cases, and > 5.33 kPa in 16.5% . The ICPs in patients with intracranial hematoma were higher than those with brain contusion (x2 = 6.43,P<0.05).When an initial value was ≥2.67 kPa,it was associated with a poor outcome (X2 =7.65,P <0.05).There were significant differences between different ICP in continuously monitoring (x2 = 13.23,P<0.05). Conclusion:The ICP monitoring may reflect the variations of clinical status and judge prognosis. It can early find secondary brain damages and direct their treatments too.