CT环池分级结合颅内压监测在去骨瓣减压术后的应用

Cisterna ambiens classification of CT imaging combined with continuous monitoring of intracranial pressure for the treatment of severe traumatic brain injury patients following decompression craniectomy

目的研究CT环池分级结合持续颅内压监测在重型颅脑创伤患者行单侧去骨瓣减压术后的应用。方法对19例去骨瓣减压术并行颅内压监测的患者,记录颅内压值(ICP)和头颅CT环池分级(Ⅰ级:环池完全闭塞;Ⅱ级:0.1~1.0 mm;Ⅲ级:1.0~2.0 mm);并行术后3个月GOS预后评分,5分、4分归为恢复良好,评分3分、2分、1分为预后不良;对这些因素行统计学分析。结果去骨瓣减压术后环池分级与ICP存在负相关性,环池分级越低,ICP越高,差异具有统计学意义。环池分级、颅内压与预后存在相关性,术后ICP24 h水平与患者预后相关性最强。恢复不良组的ICP值(43.60±17.92)mm Hg明显高于恢复良好组(14.18±6.62)mm Hg,差异有统计学意义(P<0.05)。结论评估去骨瓣减压术患者预后,ICP监测优于环池分级,术后ICP24 h与预后存在负相关;去骨瓣减压术后环池分级可反应ICP水平;运用ICP监测,可指导治疗和评估预后。

Objective The value of cisterna ambiens classification of CT imaging and intra-operative continuous monitoring of intracranial pressure （ICP） in the treatment of patients with severe traumatic brain injury （sTBI） following unilater decompression craniectomy was explored. Methods ICP monitoring and brain CT examination were perfomed in 19 patients who were perfomed the decompressive craniectomy after severe traumatic brain injury. The ICP value and cistema ambiens were recorded, and cistema ambiens degree was classified as followings： Grade Ⅰ： the central pool of occlusion; Grade Ⅱ： 0.1 - 1.0 mm; Grade Ⅲ： 1.0 -2.0 ram. GOS of 5 and 4 after three months of injury were considered as good outcome, and GOS of 3, 2 and 1 were considered as poor outcome. Then statistical analyses were performed based on these factors （CA, ICP and prognosis）. Results There was a negative correlation between basal cisterns classification and ICP level after operation; and the lower the basal cisterns classification, the higher the ICP, the difference between different groups were statistically significant. A correlation between cistema ambiens classifications, ICP level and prognosis was found. Strongest correlation was found between prognosis and ICP at 24 h after injury. The ICP value of poor prognosis group was much significantly higher than that of good prognosis group [ICP value for poor prognosis was （43.03±17.92） mmHg, ICP value for good was （14.18 ±6.62） mmHg] （P 〈0.05）. Conclusion ICP is superior to cisterna ambiens classification for assessing prognosis of decompressive cranieetomy patients with traumatic brain injury. There is negative correlation between ICP level and prognosis after traumatic brain injury. Cistema ambiens classification can reflect ICP level. The application of ICP monitoring can guide the therapy and evaluate the prognosis.