ICP联合TCD监测外伤性蛛网膜下腔出血的临床研究

Transcranial Doppler combined with ICP in monitoring traumatic subarachnoid hemorrhage

目的探讨脑室型颅内压(ICP)监测联合经颅多普勒(TCD)对外伤性蛛网膜下腔出血(t SAH)的治疗指导及预后判断。方法 45例t SAH患者入院后即行TCD动态监测及脑室型ICP探头置入术,术后持续ICP监测及脑脊液引流。依据ICP、TCD初始值制定患者的治疗策略。按脑血管痉挛程度分组,比较入院及术后6个月的Karnofsky功能状态评分,判定预后。结果 25例ICP初始值>40 mm Hg,其中24例开颅手术,1例入手术室后出现中枢衰竭放弃手术。格拉斯哥预后评分死亡10例,植物生存4例,重残7例,中残2例,良好2例。ICP初始值20~40 mm Hg 8例,其中4例行开颅手术;植物生存1例,重残1例,中残1例,良好5例;ICP初始值15~20 mm Hg 12例,11例保守治疗,1例入院后第2天行手术治疗,均预后良好。开颅前后ICP、TCD变化比较,差异有统计学意义。ICP联合TCD对t SAH导致的无、轻及中度脑血管痉挛患者远期生活评分改善明显。结论早期连续ICP、TCD监测对指导t SAH患者的治疗有积极作用。

Objective To evaluate treatment guidelines and judgment of prognosis for traumatic subarach- noid hemorrhage （tSAH） by transcranial Doppler （TCD） combined with intracranial pressure （ICP） monitoring. Methods A retrospective study was performed in 45 patients with traumatic subarachnoid hemorrhage who were confirmed on a CT scan. All of the patients received the implantation of intraventricular ICP probe and continuously TCD after admission. Postoperative intraeranial pressure and drainage of cerebrospinal fluid were monitored. Then the corresponding treatment strategies were determined in accordance with the initial ICP and TCD value. They were grouped according to cerebral vasospasm （CVS）. KPS scores at admission and 6 months after surgery were compared to determine the prognosis. Results Initial ICP value was more than 40 mmHg in 25 patients, among which 24 eases underwent craniotomy, 1 case gave up surgery because of central exhaustion in the operating room. The 25 patients had different Glasgow Outcome Scale scores including 10 cases who died, 4 cases who remained in a vegetative state, 7 with severe disability, 2 with moderate disability, and 2 with good recovery. In the 8 cases with initial ICP of 20-40 mmHg, 4 underwent craniotomy; 1 patient remained in vegetative state, 1 had severe disability, 1 had moderate disability, and 5 had good recovery. In the 12 cases with initial ICP of 15-20mmHg, 11 underwent conservative treatment, 1 received operation on the next day after admission, all had good recovery. There were significant differences in ICP and TCD before and after craniotomy. ICP monitoring combined with TCD obviously improved KPS scores in the tSAH patients without CVS or with mild or moderate CVS. Conclusions Early continuous ICP monitoring combined with TCD has a positive effect in guidance of treatment for patients with tSAH.