有创颅内压监测在中重型颅脑创伤中的应用价值

Value of intracranial pressure monitoring in treatment of traumatic moderate-severe craniocerebral injury

目的探讨有创颅内压监测在中重型颅脑创伤治疗过程中的指导作用和预后判断价值。方法溧水区人民医院神经外科于2016年11月至2017年10月收治并行手术治疗的55例中重型颅脑外伤患者,其中入院格拉斯哥昏迷量表(GCS)评分在3~5分者22例,GCS评分6~8分者10例,GCS评分>9分者23例;行脑室型ICP传感器置入8例,脑实质型ICP传感器置入47例。根据患者的预后分为预后良好组[格拉斯哥预后量表(GOS)评分4~5分]和预后不佳组(GOS评分1~3分),分析并比较两组患者有创颅内压监测值的波动情况及其对手术操作和预后的影响。结果本组患者中预后良好者(GOS评分5分)6例(11%),中残(GOS评分4分)15例(28%),重残(GOS评分3分)9例(17%),植物状态(GOS评分2分)7例(13%),死亡(GOS评分1分)18例(31%)。两组的颅内压数值在置入时初始、术后变化的均值,以及两组各步骤间颅内压波动变化的差异有统计学意义(均P<0.01)。结论颅内压实时监测能够在重型颅脑外伤患者治疗过程中及时反映大脑顺应性变化及血流供应状况,有效指导阶梯治疗操作;同时也是患者预后评估的重要参考依据。

Objective To evaluate the application value of invasive intracranial pressure monitoring in the treatment of moderate-severe craniocerebral trauma. Methods The clinical data of patients with moderate-severe craniocerebral trauma underwent neurosurgery operation from November 2016 and October 2017,were analyzed retrospectively. Of 55 patients,22 were included with admission GCS score in 3-5 points. 10 of GCS score was 6-8 points,and the cases of GCS score over 9 points were 23. There were 8 cases placed the ICP sensor in the ventricle,and 47 were put into the brain parenchymal ICP sensor. According to the prognosis the patients were divided into good group（ GOS 4-5 points） and poor groups（ GOS 1-3 points）. The two groups of open-brain surgery in patients with ICP variation and its impact on operation and prognosis were analyzed and compared. Results 6 cases（ 11%） had satisfactory prognosis（ GOS5）,15（ 28%） moderate disability（ GOS4）,9（ 17%） severe disability（ GOS 3）,7（ 13%） in vegetative state（ GOS2） and 18（ 31%）were dead（ GOS1）. Two groups of intracranial pressure numerical value in the initial,closed cranial placement and postoperative changes of the mean and the change of intracranial pressure fluctuations between the two groups of each step difference were statistically significant（ all P 〈0. 01）.Conclusions The real-time monitoring of intracranial pressure in the treatment of severe head trauma patients in the process of timely reflects blood flow to the brain and the elasticity of the brain tissue. According to the ICP value,effective operation of the ladder therapy is guided. Meanwhile,the ICP value is important reference to the evaluation of the prognosis of patients.