无创颅内压监测对治疗创伤性急性弥漫性脑肿胀的临床价值

Clinical Value of Noninvasive Intracranial Pressure Monitoring in the Treatment of Traumatic A- cute Diffuse Brain Swelling

【目的】探讨无创颅内压（ICP）监测对治疗创伤性急性弥漫性脑肿胀（PADBs）的临床指导作用。【方法】回顾性分析2009年1月至2014年12月长沙市解放军第163医院神经外科收治的69例PADBS患者的临床资料，均于伤后2～24h内在ICU病房予以无创颅内压监护仪（MICp-1A闪光视觉诱发电位无创颅内压检测分析仪）进行监护。根据患者入院时无创ICP值分为轻、中、重度颅内高压三种类型，根据患者临床症状、头颅CT及无创颅内压监测值予以对症治疗，比较不同类型患者的格拉斯哥预后评分（GOS）评估预后情况。【结果】本组病例预后良好率为43．5％（30／69），预后不良率56．5oA（39／69），病死率31．8％（22／69）。轻度颅内高压患者预后良好率为90．1％（10／11），中度颅内高压预后良好率为65．22％（15／23），重度颅内高压预后良好率为14．29％（5／35），轻度颅内高压患者预后良好率显著高于中、重度颅内高压预后良好者，差异具有统计学意义（均P〈0．05）。重度颅内高压患者死亡所占比例显著高于轻、中度颅内高压患者，差异具有统计学意义（均P〈0．05）。【结论】根据持续无创ICP监测结果给予对症治疗，对创伤性急性大脑弥漫性脑肿胀的治疗有重要的指导作用。

[Objective]To investigate the clinical value of noninvasive intracranial pressure monitoring in the treatment of posttraumatic acute diffuse brain swelling （PADBS） and to evaluate its significance to the prognosis. [Methods]A retrospective analysis of the clinical data of 69 patients with PADBS treated by neurosurgery from January 2009 to December 2014 in the 163 Hospital of People＇s Liberation Army was performed. All patients were in ICU ward within 2 - 24 hours after injury and were monitored by noninvasive intracranial pressure monitor （MICP-1A, flash visual evoked potential noninvasive intracranial pressure detection analyzer）. Patients were divid- ed into mild, moderate, and severe intracranial hypertension according to the value of noninvasive intracranial pressure monitoring and were treated accordingly based on their symptoms and brain CT examination. The Glas- gow prognosis scores were evaluated for patients＇ prognosis among different types of PADBS.[Results]The overall accurate prognosis rate was 43.5% （30/69） and poor prognosis rate was 56.5% （39/69）. The mortality rate was 31.8% （22/69）. The accurate prognosis rates of mild, moderate, and severe intracranial hypertension patients wereg0.1% （10 / 11）, 65.22% （15/23）, and 14.29% （5/35）, respectively. The accurate prognosis of patients with mild intracranial hypertension was significantly higher than that of moderate and severe intracranial hypertension. The difference was statistically significant （ P 〈0.05）. The proportion of death in patients with severe intracranial hypertension was significantly higher than that in patients with mild to moderate intracranial hyperten- sion; the difference was statistically significant （P 〈0.05）.[Conclusion]The value of noninvasive intracranial pressure monitor was closely related to the prognosis of PADBS patients. Continuous monitoring can provide an important indicator for the treatment of posttraumatic acute diffuse brain swelling.