颅脑损伤患者不同部位颅内压监测与治疗效果的相关性

Study on the correlation between intracranial pressure monitoring of different parts in patients with craniocerebral injury and therapeutic effect

目的 探讨颅脑损伤患者不同部位颅内压监测与治疗效果的关系。方法 将82例重型颅脑 损伤患者按照有无颅内压监测分为非监测组和监测组，监测组分为脑室内监测组和脑实质内监测组，观察 不同组别的治疗效果。结果 术后第7天脑室内监测组颅内压低于脑实质内监测组［（10.35±3.32）mmHg 比（13.46±4.71）mmHg；t=4.017，P=0.028］。脑室内监测组甘露醇使用时间（6.05±2.03）d以及剂量 （748.92±126.65）g低于脑实质内监测组［（8.46±2.41）d，（961.72±128.82）g；t=3.011，5.254，P ＜ 0.05］。 术后第7天、第14天脑室内监测组GCS评分［（9.11±2.73），（12.06±2.37）分］高于脑实质内监测组 ［（8.82±2.67），（10.09±2.23）分；t=3.403，4.562；P＜0.05）］。随访患者6个月，其中监测组总有效率（75.86%， 68.97%）均显著高于非监测组（41.67%），差异有统计学意义（χ2=5.432，6.401；P＜ 0.05）；脑室内监测组脑 积水发生率（10.34%）显著低于脑实质内监测组（3.45%）、非监测组（4.17%），差异有统计学意义（χ2=3.709， 4.421；P＜ 0.05）。结论 脑室内颅内压监测能明显降低重型颅脑损伤患者甘露醇使用、较快降低颅内高 压，预后情况良好，并发症少，值得临床应用，脑实质内监测次于脑室内监测。

Objective To investigate the relationship between intracranial pressure （ICP） monitoring of different parts in patients with craniocerebral injury and therapeutic effect. Methods A total of 82 patients with severe craniocerebral injury were divided into non-monitoring group and monitoring group according to the monitoring of ICP. The monitoring group was divided into intraventricular monitoring group and brain parenchymal monitoring group. The treatment effect of different groups was observed. Results The ICP was significantly lower in the intraventricular monitoring group （10.35±3.32）mmHg than that in the parenchymal group（ 13.46±4.71）mmHg（ t=4.017,P=0.028）. The time and dose of mannitol in the intraventricular monitoring group were significantly lower than those in the parenchymal monitoring group[ （6.05±2.03）d vs （8.46±2.41）d;（ 748.92±126.65）g vs（ 961.72±128.82）g, t=3.011,5.254;P〈 0.05]. The GCS score of the intraventricular monitoring group on the 7th and the 14th day after surgery was（ 9.11±2.73）,（ 12.06±2.37）, which was significantly higher than that of the parenchymal group[ （8.82±2.67）,（ 10.09±2.23）,t=3.403, 4.562;P 〈 0.05]. After 6 months follow-up, the total effective rate of the monitoring group was significantly lower than that of the non-monitoring group（ 75.86%,68.97% vs 41.67%;χ2=5.432,6.401;P 〈 0.05）. The incidence of hydrocephalus in the intraventricular monitoring group was significantly lower than that in the parenchymal group and non-monitoring group（ 10.34% vs 3.45%, 4.17%;χ2=3.709,4.421;P 〈 0.05）. Conclusions Intracerebral ICP monitoring can significantly reduce the use of mannitol in patients with severe craniocerebral injury, reduce the intracranial hypertension, and the prognosis is good with less complications, which is worthy of clinical application. In addition, brain parenchymal monitoring is second to intraventricular monitoring.