有创颅内压监测在儿童重型颅脑创伤中应用价值的研究

Study on application value of invasive intracranial pressure monitoring in children with severe craniocerebral trauma

目的探讨有创颅内压(ICP)监测在儿童重型颅脑创伤(sTBI)中的应用价值。方法回顾性分析2012年1月至2015年3月该院收治的158例sTBI患儿,根据是否进行有创ICP监测将其分为监测组(80例)与对照组(78例)。监测组术后24h内安装有创ICP监测,并根据ICP水平采取相应处理措施,对照组通过临床症状并根据经验判断是否需要复查头颅CT与调整治疗方案,伤后3个月按照哥拉斯哥预后评分(GOS)判断患儿预后并进行比较分析。同时,比较监测组不同ICP水平患儿预后。结果监测组预后良好率为61.2%,对照组预后良好率为41.0%,两组比较差异有统计学意义(P<0.05)。监测组不同ICP水平患儿病死率比较,差异有统计学意义(P<0.05)。结论 sTBI患儿及时安装有创ICP监测能够动态观察ICP变化,及早发现病情改变,指导临床治疗,改善患儿预后。

Objective To explore the application value of invasive intracranial pressure （ICP） monitoring in children with se- vere traumatic brain injur （sTBI）. Methods A total of 158 children with sTBI in our hospital from January 2012 to March 2015 were collected and retrospectively analysed. According to whether the child recieved invasive ICP monitoring or not, they were di- vided into the monitoring group （80 cases） and the control group （78 cases）. Children in the monitoring group were embed of inva- sive ICP monitoring device within first 24 h after surgery,and were treated with appropriate measures according to the ICP level. In the control group, the determination of whether needing to recieve head CT and adjusting the treatment program was made based on the clinical symptoms and surgeon＇s experiences. The prognosis of children in the two groups were evaluated by Glasgow coma scale （GOS） and compared at 3 months after injury. At the same time, the prognosis of children in the monitoring group with different ICP levels were compared. Results The favorable prognosis rates in the monitoring group and control group were 61.2% and 41.0 % respectively, and there was statistically significant difference between the two groups（P〈0.05）. The mortality rates of chil- dren in the monitoring group had statistical difference among different ICP levels（P〈0.05）. Conclusion For children with sTBI, the invasive ICP monitoring is contribute to dynamically observing the changes in ICP,early detecting changes of conditions,guiding clinical treatment, and improving the prognosis.