有创颅内压监测在颅脑外伤术后的应用

Invasive intracranial pressure monitoring in craniocerebral trauma

目的探讨有创颅内压监测在颅脑外伤术后的临床应用价值。方法对61例颅脑外伤行开颅手术患者,术中放置颅内压探头于硬膜下或脑室中;术后用颅内压监护仪连续观察颅内压数值,同时观察患者意识、瞳孔及生命体征变化。根据颅内压的变化及时指导、调整治疗方案。结果本组患者中,颅内压正常者25例,未使用脱水剂;其余患者均使用不同剂量的甘露醇、速尿、白蛋白、甘油果糖等降颅内压药物,应用时间为2~11 d。1例患者术后当天死亡,死亡原因为脑干功能急性衰竭。3例患者在监测过程中发现颅内压骤然升高,考虑颅内迟发性血肿或脑挫伤血肿增大,及时复查头颅CT证实诊断而行二次手术治疗。相关性分析结果显示,患者术后第1 d脱水前颅内压越高,其术后6个月时的预后越差(χ~2=9.55,P<0.05)。患者术后颅内压与格拉斯哥昏迷量表(GCS)评分呈负相关(r=-0.643,P<0.05)。结论有创颅内压监测是诊断颅脑外伤术后颅高压最迅速、客观和准确的方法,也是观察患者病情变化、早期诊断、判断手术时机、指导临床药物治疗,判断和改善预后的重要方法,值得临床重视与推广。

Objective To investigate the clinical application of invasive intracranial pressure monitoring after craniocerebral trauma operation. Methods 61 cases of craniocerebral trauma underwent operation were selected from Jan. 2015 to Jun. 2016 in our hospital. Codman intracranial pressure monitor was used intraoperatively. Intracranial pressure data were continuously observed and recorded postoperatively. Meanwhile,patients＇ awareness,pupil and vital signs were observed closely.The therapy plan could be decided or adjusted in time according to the monitoring results.Results 25 cases of normal ICP in this group,without the use of dehydrating agents,the rest of the patients were using different doses of intracranial pressure lowering drugs such as mannitol,furosemide,albumin and glycerol fructose. The application of time for 2 to 11 days. One of the cases died on the day of the operation,the cause of death was the acute brain stem function failure. 3 cases in the monitoring process found a sudden increase in intracranial pressure were considered delayed intracranial hematoma or brain contusion hematoma increased. Timely CT review confirmed diagnosis and conducted secondary surgery. The relationship between the ICP before dehydration at the first day after surgery in patients and the prognosis 6 months later were observed and it was found that the higher the intracranial pressure,the worse the prognosis（ χ~2= 9. 55,P 0. 05）. Correlation analysis results showed that there was a negative correlation between ICP and GCS（ r =-0. 643,P 0. 05）.Conclusions The invasive intracranial pressure monitoring is the most rapid, objective and accurate method. It is also an important method such as to observe the change of patients＇ condition,early diagnosis,determine the timing of the operation,guiding drug prescription,to judge and improve prognosis. In summary,it is worth attention and promotion.