闪光视觉诱发电位颅内压监护技术结合头颅CT对单侧脑挫裂伤患者继发血肿变化的临床研究

Clinical study of flash visual evoked potential-noninvasive intracranial pressure combined with head CT to the change of secondary intracranial hematoma after unilateral cerebral laceration

目的探讨闪光视觉诱发电位颅内压监护技术（FVEP-NICP）在单侧脑挫裂伤患者继发颅内血肿扩大的预警作用及对预后的判断意义。方法前瞻性应用FVEP—NICP监测技术对2012年至2013年解放军153医院收治的96例单侧脑挫伤患者进行监护，结合头颅CT分为血肿增加组与血肿稳定组，对两组的NICP及挫伤侧与健侧NICP的差值（D值）及预后进行对比分析，预后根据伤后6个月的GOS评分分为恢复良好患者（GOS4—5分）与恢复不良患者（GOS1-3分）。结果血肿增加组38例（39．6％）的NICP值及D值较入院时显著增高（P值分别为0．015和0．002）；血肿稳定组58例（60．4％）的NICP值及D值较入院时无明显增高（P值分别为0．583和0．621）；对D值≥60mmH，O（1mmH，O=0．0098kPa）的人数分析，入院首测两组之间差异未见统计学意义（P〉0．05），复测时血肿增大组人数较血肿稳定组显著增多（P〈0．01）。血肿增加组恢复良好患者15例（39．5％），恢复不良者23例（60．5％）；血肿稳定组恢复良好者49例（84．5％），恢复不良者9例（15．5％），血肿增大组预后良好率显著低于血肿不变组（P=0．013）。结论闪光视觉诱发电位无创颅内压监测技术结合头颅CT对单侧脑挫裂伤患者继发血肿增大具有良好的预警作用。

Objective To investigate the clinical significance of flash visual evoked potential- noninvasive intracranial pressure monitoring and prognostic of early-warning hematoma enlargement in pa- tients with secondary intracranial hematoma of unilateral cerebral laceration. Methods Ninety-six cases with unilateral cerebral laceration were continuously monitored FVEP-NICP in the 153rd Hospital of PLA from 2012 to 2013, they were divided into the hematoma expanded group and the hematoma stable group based on brain CT. An analysis and comparision between the two groups were performed focusing on characteristics, such as the differences of NICP between the hematoma side and the healthy side （D val- ue）, and the Glasgow prognosis scores（GOS） were analyzed and compared between the two groups. Pa- tients prognosis were divided into recovery well（ GOS 4 - 5 ） and lack of recovery （ GOS 1 - 3 ） according to the GOS of 6 months after injury. Results NICP and D value in the hematoma expanded group sig- nificantly increased from first detection （P = 0. 015 and 0. 002 ） , while there were no significant in- creasing of NICP and D value in hematoma stable group （P = 0. 538 and 0. 621 ）. In hematoma group, 15 cases recovered well, 23 cases were lack of recovery. In hematoma stable group, 49 cases recovered well, 9 cases were lack of recovery. The rate of favorable prognosis of hematoma expanded group was significantly lower than that of the hematoma stable group （P = 0. 013 ）. Conclusions FVEP-NICP combined with head CT has good warning effect on patients with secondary intracranial hematoma of unilateral cerebral laceration.