儿童颅脑创伤后颅内压及脑灌注压的临床特点

Clinical features of intracranial pressure and cerebral perfusion pressure after craniocerebral trauma in children

目的分析儿童颅脑创伤后颅内压及脑灌注压的临床特点，为临床治疗提供理论依据。方法回顾性分析2012年9月—2013年10月行有创颅内压监测的颅脑创伤儿童68例，按年龄分为0～2岁组（13例）、2～7岁组（33例）和7～16岁组（22例），分析不同年龄组的颅内压、脑灌注压随时间、年龄的变化特点，及其与预后的关系和影响因素。结果术后24h左右颅内压达高峰，脑灌注压达低谷，前者在3～5d后逐渐下降并稳定，后者在2～3d后轻微回升并稳定。颅内压水平：0～2岁组（16.1±1.6）mmHg，2～7岁组（16.9±1.6）mmHg，7～16岁组（19.9±1.5）mmHg，两两比较差异有统计学意义（P〈0.05）。脑灌压水平：0～2岁组（52.5±2.3）mmHg，2～7岁组（54.3±1.7）mmHg，7～16岁组（58.0±1.9）mmHg，两两比较差异有统计学意义（P〈0.01）。颅内压≥30mmHg、脑灌注压〈40mmHg与患儿预后不良有关。结论制订年龄特异性的颅内压和脑灌注压治疗阈值，对颅脑创伤儿童的治疗及预后判断有重要指导意义。

Objective To analyze the clinical characteristics of intracranial pressure and cerebral perfusion pressure after eranioeerebral trauma in children so as to guide the clinical therapy. Methods A retrospective review was conducted on 68 children with craniocerebral trauma undergone continuous invasive intracranial pressure monitoring from September 2012 to October 2013. The children were assigned to 3 age groups： 0-2 years （13 cases）, 2-7 years （33 cases）, and 7-16 years （22 cases）. Characteristics of intracranial pressure and cerebral perfusion were detected over time and age and measured for their correlation with the prognosis and related influential factors. Results Intracranial pressure ascended to the peak point at postoperative 24 hours and decreased to a stable level at postoperative 3 - 5 days. Cerebral perfusion pressure descended to the valley at postoperative 24 hours, followed by a slight return and stabilized at postoperative 2-3 days. Intracranial pressure was （ 16.1 ±1.6） mmHg in children aged 0- 2 years, （ 16.9±1.6） mmHg in children aged 2-7 years, and （ 19.9±1.5） mmHg in children aged 7- 16 years, with statistical difference in pair comparison （P 〈 0.05 ）; cerebral perfusion pressure was （52. 5±2.3 ） mmHg in children aged 0-2 years, （54.3±1.7 ） mmHg in children aged 2-7 years, and （58.0±1.9） mmHg in children aged 7-16 years, with statistical significance in pair comparison （P 〈 0.01 ）. Intracranial pressure 〉 30 mmHg and cerebral perfusion pressure 〈 40 mmHg were associated with poor outcome. Conclusion Age-specific thresholds developed for intracranial pressure and cerebral perfusion pressure is instructive to the clinical therapy and prognostic prediction.