颅内压及脑电双频指数联合监测在重型颅脑外伤患者术后临床应用中的研究

Combined monitoring of intracranial pressure and bispectral index in patients with severe craniocerebral trauma after operation

目的探讨脑电双频指数及颅内压监测在重型颅脑外伤患者术后意识评测和短期预后评估中的应用价值。方法采用简单随机抽样法随机选择2014年1月-12月江苏省苏北人民医院神经外科重症监护病房颅脑外伤昏迷患者30例，每8h评价患者的GCS评分，记录患者手术治疗后3d内的GCS评分，记录相同时刻的脑电双频指数值及颅内压值，依据GCS评分将患者分为两组：A组20例（3分≤GCS≤5分），B组10例（5分〈GCS≤8分），统计两组患者的21d生存率。采用Kaplan—Meier法和Log．rank检验比较脑电双频指数值和颅内压之间的关系。结果A组脑电双频指数值为45．3-4-3．8，颅内压值为（18．6±2．8）mmHg，B组脑电双频指数值为32．2±8．2，颅内压值为（33．4±4．6）mmHg，A组21d生存率为55％，B组21d生存率为30％，重型颅脑外伤患者术后脑电双频指数值与昏迷程度呈正相关，与颅内压值呈负相关（r=0．532，P〈0．05；r=0．521，P〈0．05）。重型颅脑损伤患者，人院时病情越重，患者术后颅内压越高，脑电双频指数值越低，其预后越差。结论脑电双频指数与颅内压联合监测在评估重型颅脑外伤患者术后昏迷程度及预后方面具有较高的应用价值。

Objective To investigate the value of bispectral index and intracranial pressure monitoring in evaluation of postoperative consciousness and short-term prognosis in patients with severe traumatic brain injury. Methods A simple random sampling method was used in 30 cases of brain trauma coma patients in the People＇s Hospital of Northern Jiangsu Province from January 2014 to December 2014. Glasgow coma scale （GCS） were evaluated at intervals of 8 hours, GCS were recorded for 3 days after surgery, The bispectral index value and intracranial pressure value are recorded at the same time. According to GCS, the patients were divided into two groups, group A （3≤GCS≤5） and group B（5 〈 GCS~〈8）. The 21-days natural survival rate was counted. The Kaplan-Meier Method and Log-rank test were used to analyze the relationship between Bispectral index and intracranial pressure. Results The bispectral index value of group A was 45.3± 3.8, the intracranial pressure value of group A was （ 18.6 ± 2.8 ） mmHg, The bispectral index value of group B was 32.2 ± 8.2, the intracranial pressure value of group B was （33.4 ±4.6） mmHg. The 21-days survival rate of group A was 55% , and 21-days survival rate of group B was 30%. The Spearman rank correlation method was used to analyze the values. Bispectral index value was positively correlated with coma degree after operation in patients with severe traumatic brain injury, and was negatively correlated with intracranial pressure value （ r = 0. 532, P 〈 0. 05 ; r = 0. 521, P 〈 0.05 ）. The more severer the patient＇s craniocerebral injury, the more severer the condition, the higher the intracranial pressure, the lower the bispectral index value, the worse the prognosis is. Conclusion Combined monitoring of bispectral index and intracranial pressure has high application value in evaluating the coma degree and prognosis of patients with severe cranioeerebral injury after operation.