颅内压监测在特重型颅脑损伤患者中的临床应用价值探讨

The Clinical Application Value of Intracranial Pressure Monitoring in Patients with Severe Craniocerebral Injury

目的探讨颅内压监测在特重型颅脑损伤患者中的临床应用价值。方法将2014年7月至2019年4月在我院神经外科治疗的60例特重型颅脑损伤患者随机分为两组,对照组行去标准大骨瓣减压术及清除颅内相关病灶后、不采用颅内压监测,观察组行去标准大骨瓣减压术后将调零后的基本型传感器探头经头皮隧道置于颞骨硬膜下、中脑水平,并妥善固定,接颅内压监测仪,部分患者根据病情术中需留置侧脑室引流,选用脑室型的带导管的颅内压传感器,比较两组患者的预后、甘露醇应用剂量及时间、术后颅内压监控水平、并发症发生率。结果观察组预后良好率明显高于对照组,而病死率明显低于对照组(P<0.05),但在中残、重残及植物生存率上无明显差异(P>0.05)。观察组甘露醇应用剂量明显少于对照组,且应用时间明显短于对照组(P<0.05);观察组24 h的颅内压水平与对照组相比无明显差异(P>0.05),但术后72 h、120 h的颅内压水平明显低于对照组(P<0.05);观察组重度脑水肿、颅内感染、呼吸异常、心电图异常等并发症发生率明显低于对照组(P<0.05)。结论采用颅内压监测探头监测特重型颅脑损伤患者的效果显著,能有效控制颅内压,改善患者预后,减少甘露醇用量及使用时间,降低并发症发生率,具有积极的临床意义。

Objective To explore the clinical application value of intracranial pressure monitoring in patients with severe brain injury.Methods In July 2014-February 2019 in our hospital neurosurgery treatment of 60 cases of track,craniocerebral injury patients were randomly divided into two groups,in the control group,the intracranial pressure was not monitored after standard large bone fl ap decompression and removal of related intracranial lesions.In the observation group,after decompression with the standard large bone fl ap,the basic sensor probe after zero adjustment was placed through the scalp tunnel under the dura mater of the temporal bone,the midbrain level was properly fi xed,and the intracranial pressure monitoring instrument was used.According to the need for indwelling lateral ventricular drainage in some patients during the operation,intracranial pressure sensors with catheters of cerebral ventricular type were selected.Compared two groups of patients prognosis,applications of mannitol dosage and time,postoperative intracranial pressure monitoring level,the incidence of complications.Results The rate of good prognosis in the observation group was signifi cantly higher than that in the control group,while the mortality was signifi cantly lower than that in the control group(P<0.05),but there was no signifi cant difference in the rates of moderate disability,severe disability and plant survival(P>0.05).The dose of mannitol in the observation group was signifi cantly lower than that in the control group,and the application time was signifi cantly shorter than that in the control group(P<0.05).The level of intracranial pressure in the observation group at 24 h was not signifi cantly different from that in the control group(P>0.05),but the level of intracranial pressure at 72 h and 120h after surgery was signifi cantly lower than that in the control group(P<0.05).The incidence of severe cerebral edema,intracranial infection,respiratory abnormalities,ecg abnormalities and other complications in the observation group was signifi cantly lower than that in the control group(P<0.05).Conclusion Intracranial pressure monitoring probe can effectively control intracranial pressure,improve the prognosis of patients,reduce the amount of mannitol and use time,and reduce the incidence of complications,which has a positive clinical signifi cance in monitoring extra-severe craniocerebral injury patients with intracranial pressure monitoring probe.