去骨瓣减压术后颅内压持续监测对重型颅脑损伤患者预后的影响

Effect of continuous reduction of intracranial pressure on the prognosis of patients with severe traumatic brain injury

目的探讨基于颅内压持续监测的去骨瓣减压术对重型颅脑损伤患者预后的影响。方法选取本院神经外科2014年1月至2017年1月收治的60例重型颅脑损伤患者,随机分为观察组和对照组,每组30例。两组患者均接受骨去瓣减压术治疗,观察组患者实施颅内压持续监测,对照组患者则实施一般颅内压监测。比较分析两组患者的并发症发生情况及预后情况。结果两组患者肺部感染、尿路感染和上消化道出血发生率差异无显著性(P>0.05),但观察组急性肾功能损伤、电解质紊乱的发生率(分别为6.67%、26.67%)明显低于对照组(分别为33.33%、56.67%),差异有显著性(P<0.05)。观察组患者甘露醇应用时间及剂量明显低于对照组,预后情况明显优于对照组,差异均有显著性(P<0.05)。结论重型颅脑损伤患者去骨瓣减压术后行颅内压持续监测可减少术后并发症的发生,改善患者的预后。

Objective To investigate the effect of continuous reduction of intracranial pressure on the prognosis of patients with severe craniocerebral injury. Method 60 patients with severe head injury were enrolled in Department of Neurosurgery, Shanghai Pudong New Area Gongli Hospital from January 2014 to January 2017. They were randomly divided into observation group and control group,each group had 30 patients. Two groups of patients were treated with bone flap decompression, which observed the implementation of continuous intracranial pressure monitoring, the control group is the implementation of general intracranial pressure monitoring. Statistics of the two groups of patients with complications and treatment of prognosis. Result The incidence of pulmonary infection, urinary tract infection and upper gastrointestinal hemorrhage was similar in two groups（P〉0.05）, while the incidence of acute kidney injury and electrolyte disturbance in observation group（6.67%, 26.67%, respectively） was higher than that in control group（33.33%, 56.67%, respectively）, the difference was statistically significant（P〈0.05）. The mannitol application time and dosage in the observation group was significantly less than that in the control group（P〈0.05）. The prognosis of the patients in observation group was significantly better than that in the control group（P〈0.05）. Conclusion The treatment of severe craniocerebral injury by bone flap decompression based on continuous monitoring of intracranial pressure can significantly improve the curative effect of clinical treatment and reduce the incidence of complications. It is worthy to be popularized in clinical practice.