术中持续颅内压监测在重型颅脑损伤中的运用研究

Study on application of intraoperative continuous intracranial pressure monitoring to severe craniocerebral injury

目的探讨术中颅内压监测在重型颅脑损伤治疗中的意义。方法收集58例重型颅脑损伤行去骨瓣减压术患者,均予术中颅内压监测,动态记录术前、术中的颅内压情况。术后随访6个月,GOS预后评分4～5为预后良好,1～3分为预后不良。结果术中发生急性脑膨出3例,迟发性颅内血肿4例,其中2例迟发性颅内血肿出现急性脑膨出。全部病例中,出现减压后颅内压反弹升高超过15 mm Hg患者共8例（14.3%）;而7例（87.5%）发生急性脑膨出和迟发性颅内出血的病例均出现减压后颅内压反弹升高超过15 mm Hg。随访6个月,GOS评分不良者占41.4%;而发生术中并发症的患者评分不良者比例高达85.7%（6/7）,且3例死亡均来自发生并发症的患者。结论去骨瓣减压术中发生严重并发症与不良预后相关,术中监测减压后颅内压反弹升高幅度,有助于预防和控制术中并发症的发生,改善患者预后。

Objective To explore the significance of intraoperative intracranial pressure monitoring in treatment of severe craniocerebral injury. Methods Total 58 patients with severe craniocerebral injury were selected and they were treated with decompressive craniectomy. Intraoperative intracranial pressure monitoring was carried out, and preoperative and intraoperative intracranial pressures were recorded dynamically. The follow-up period lasted six months. For COS prognostic score, scores from four to five showed a good prognosis and scores from one to three showed a poor prognosis. Results Intraoperative acute encephalocele occurred in three cases and delayed intracranial hematoma occurred in four cases,including two cases of acute encephalocele occurring in the cases of delayed intracranial hematoma. In all cases, the rebounded increase of intracranial pressure after decompression exceeded 15 mmHg in eight cases （ 14.3% ）, including seven cases of acute encephalocele and delayed intracranial hemorrhage （ 87.5% ）. During the follow-up period,the rate of poor GOS scores accounted for 41.4% ;for the patients with intraoperative complications, the rate of poor GOS scores accounted for up to 85.7% （6/7）, and death occurred in three cases of complications. Conclusion Severe complications during decompressive craniectomy are associated with poor prognosis ;intraoperative monitoring of the rebounded increase of intracranial pressure after decompression is helpful to the prevention and control of intraoperative complications, as well as the improvement of prognosis of the patients.