术中超声引导下脑室穿刺术监测颅内压在创伤后弥漫性脑肿胀治疗中的应用

Intracranial pressure monitoring in ventricular puncture by intraoperative ultrasonography in treatment of posttraumatic diffuse brain swelling

目的 探讨术中实时超声引导下行脑室穿刺术监测颅内压在创伤后弥漫性脑肿胀患者治疗中的临床应用价值.方法 选择新疆医科大学第一附属医院院神经外科自2015年1月至2017年12月在术中实时超声引导下行脑室穿刺术监测颅内压的创伤后弥漫性脑肿胀患者67例(研究组)和本科室自2012年1月至2014年6月采用传统脑室穿刺术监测颅内压的创伤后弥漫性脑肿胀患者71例(对照组),回顾性分析患者的临床资料,比较2组患者一次穿刺成功率和并发症的发生情况.结果 研究组患者中一次穿刺成功67例(100.0%),对照组患者中一次穿刺成功55例(77.5%),差异有统计学意义(P<0.05).2组患者均未发生导管相关性感染.研究组患者出现穿刺道血肿1例,穿刺位置均在正常位置.对照组患者出现穿刺道血肿9例,穿刺位置异常8例,其中5例穿刺未能在脑室内,1例穿刺至对侧脑室,2例穿刺深度过大.研究组患者穿刺道血肿、穿刺位置异常发生率均低于对照组,差异有统计学意义(P<0.05).结论 术中超声引导下行脑室穿刺术较传统的脑室穿刺术成功率高,且更安全,能够更精准地指导治疗创伤性颅损伤(TBI),值得在基层医院开展.

Objective To investigate the clinical efficacy of intracranial pressure monitoring in ventricular puncture for patients with posttraumatic diffuse brain swelling under guidance of real-time intraoperative ultrasound. Methods Sixty-seven patients with posttraumatic diffuse brain swelling, admitted to and accepted intracranial pressure monitoring in ventricular puncture under real-time intraoperative ultrasound in our hospital from January 2015 to December 2017, were chosen as experimental group; and other 71 patients with posttraumatic diffuse brain swelling, admitted to and accepted traditional intracranial pressure monitoring in ventricular puncture in our hospital from January 2012 to June 2014, were chosen as control group. The clinical data were retrospectively analyzed, and the success rate of primary puncture and complications were compared between the two groups. Results The success rate of primary puncture in the experimental group was 100% (67/67), and that in the control group was 77.5% (55/71), with significant difference (P<0.05). No catheter-related infection was noted in either group. Only one patient in study group had puncture tract bleeding, while 9 patients in the control group had puncture tract bleeding; abnormal puncture location was noted in 8 patients of the control group, including 5 failing to be punctured in the ventricle, one puncturing to the contralateral ventricle, and two having excessive puncture depth; occurrence of postoperative complications in study group was significantly lower than that in control group (P<0.05). Conclusion Real-time intraoperative ultrasound-guided puncture ventricle drainage is superior to conventional bind-puncture in traumatic patients with diffuse brain swelling, and can be widely used in clinical practice.