颅内压监测与阶梯式治疗方案治疗颅脑损伤

Stepwise therapy in the treatment of traumatic brain injured patients guided by intracranial pressure monitoring

目的探讨无创颅内压监测与阶梯式治疗方案在颅脑损伤治疗中的价值。方法前瞻性分析2013年10月至2014年8月我院收治72例颅脑损伤患者,随机分为对照组与监测组,每组各36例。对照组应用传统的观察及治疗方法;监测组根据GCS评分分别进行有创(GCS≤8)、无创(GCS>8)颅内压监测,根据颅内压、患者生命体征、GCS变化指导采取个体化阶梯式治疗方案控制颅内压并观察各组患者甘露醇用量、开颅手术治疗例数、ICU住院天数、6月后GOS评分评价疗效。结果监测组甘露醇用量、开颅手术例数较对照组明显减少(P<0.01)。重症TBI患者平均ICU住院天数监测组较对照组明显缩短。GOS评分监测组明显优于对照组(P<0.01)。结论对颅脑外伤患者无论在有创、无创ICP监测指导下调整阶梯式个性化治疗措施,均能减少甘露醇用量,缩短ICU住院天数,提高患者预后,应该在临床大力推广。

Objective： To explore the values of invasive,non-invasive intracranial pressure（ ICP） monitoring in stepwise therapy of traumatic brain injury（ TBI）. Medthods： Seventy-two patients with TBI were randomly divided into ICP monitoring group and conventional therapy group（ control group） admitted at Department of Neurosurgery,Laiwu People ＇s Hospital Affiliated to Taishan Medical University from Oct. 2013 to Aug. 2014 and were evaluated prosepectively. The control group had traditional observation and treatment. Monitoring group was divided into two groups of invasive（ GCS≤8）and noninvasive（ GCS 〉8） ICP monitoring according to GCS score. ICP,vital signs and GCS score changes of patient were used to guide individualized and stepwise treatment. Control of intracranial pressure change,GOS score and mannitol dosage were observed to evaluate the effect of the treatment. Results： Compared with the traditional group,the dose of mannitol monitoring group significantly reduced（ P〈0. 01）. At follow-up of 6 months,GOS score of ICP monitoring group was significantly better than that of the control group（ P〈0. 01）. Conclusion： ICP monitoring significantly reduces the doseage and duration of mannitol therapy,for TBI TBI patients ICP should be monitored as early as possible. ICP monitoring can help the finding changes of patients＇ condition timely,guidance and adjustment of individualized and stepwise treatment in time. It can aslo improve prognosis,and therefore is worthy of clinical application.