颅内压检测及脑脊液乳酸水平对重型颅脑损伤患者预后预测研究

Prediction of detection of intracranial pressure and cerebrospinal fluid lactic acid levels in the prognosis of patients with severe brain injury

目的研究颅内压检测及脑脊液乳酸水平对重型颅脑损伤患者预后的预测价值。方法 2014年5月—2018年1月蚌埠市第一人民医院重症医学科收治重型颅脑损伤并进行手术患者68例,其中男性38例,女性30例;年龄40～78岁,平均61.28岁;受伤至入院时间(4.61±1.34)h;致伤原因:高血压脑出血60例,道路交通伤4例,高处坠落伤4例。患者均在术后采用无创颅内压检测仪连续监测并记录颅内压同时设定预警值,并根据变化情况给予适当的干预。同时对患者行腰椎穿刺收集脑脊液检测乳酸水平。将患者颅内压变化情况与GCS评分及CT复查结果进行比对,采用格拉斯评价量表对患者的预后进行评估,比较预后不同组别间患者脑脊液乳酸水平的差异,并分析颅内压预警结果与预后的关系。结果术后2h后颅内压轻度增高患者21例(30.88%),GCS评分降低0～1分,CT复查结果显示未发现挫裂伤与迟发性血肿;中度增高患者32例(47.09%),GCS评分下降2～3分,CT复查结果显示颅内挫伤与迟发性水肿均有一定程度的增大;重度增高患者15例(22.06%),GCS评分降低>3分,CT复查结果显示颅内挫伤与迟发性水肿均明显增大;随着颅内压增高程度上升,患者的恢复良好率、轻度缺陷残疾率越低,而重度残疾率、植物生存率与病死率越高(P<0.05);随着脑脊液乳酸水平增加,患者的恢复良好率、轻度缺陷残疾率越低,而重度残疾率、植物生存率与病死率越高(P<0.05)。结论随着颅内压和脑脊液乳酸水平的增加,重症颅脑损伤患者的预后越差,可见在重症颅脑损伤患者治疗过程中对上述两种指标的观察和控制,对于重症颅脑损伤患者的恢复具有积极的作用。

Objective To study the predictive value of intracranial pressure testing and cerebrospinal fluid lactic acid levels in the prognosis of patients with severe head injury. Methods A total of 68 patients with severe craniocerebral injury admitted to our hospital from May 2014 to Jan. 2018 were enrolled. There were 38 males and 30 females with an average age of 61.28(40-78) years. The time from injury to admission was(4.61±1.34) hours. Causes of injury included 60 cases of high-pressure haemorrhage,4 cases of road traffic injury,and 4 cases of fall injury. All patients underwent continuous monitoring and recording of intracranial pressure after nonoperative intracranial pressure test. At the same time,the warning value was set and appropriate intervention was given according to the change. The patient was given lumbar puncture and cerebrospinal fluid was collected to detect lactic acid levels. The intracranial pressure changes were compared with the GCS scores and CT findings. The patients’ prognosis was evaluated by the Grasse evaluation scale. The differences in cerebrospinal fluid lactate levels between patients with different prognosis were compared,and the intracranial pressure warning was analyzed. The relationship between outcome and prognosis was analyzed. Results Totally 21 patients(30.88%) with mild intracranial pressure increased 2 hours after operation,GCS score decreased by 0-1 points, and CT findings showed no contusion or delayed hematoma;32 patients had moderate increase(47.09 %),GCS score decreased by 2-3 points,and CT review showed that intracranial contusion and delayed edema had a certain degree of increase;15 cases(22.06%) with severe increased GCS score decreased by more than 3 points,and CT review results showed that intracranial contusion and delayed edema were significantly increased;with the increase of intracranial pressure,the recovery rate and mild defect disability rate were lower,and the higher the severe disability rate was,the higher the plant survival rate and mortality rate were(P<0.05);with the increase of lactic acid level in cerebrospinal fluid,the rate of patients with good recovery and mild disability was lower,while the rate of plants with severe disability was higher(P<0.05). Conclusion With the increase of intracranial pressure and the level of cerebrospinal fluid lactic acid,the prognosis of patients with severe craniocerebral injury is worse. It can be seen that the observation and control of the above two indicators in the treatment process of patients with severe craniocerebral injury has a positive effect on patients, recovery.