颅内压监测指导甘露醇应用对开颅术后患者临床效果的影响

Clinical Effects of Intracranial Pressure Monitoring for Guidance of Mannitol Application on Patients after Craniotomy

目的:探讨颅内压(ICP)监测指导甘露醇应用对开颅术后患者疼痛、认知功能、并发症及疗效的影响。方法:115例行开颅手术患者随机分为观察组(ICP监测指导甘露醇应用,n=65)和对照组(根据传统的临床观察方式应用甘露醇,n=50),采用简易智能精神状态评分(MMSE)评价2组患者术前1天、术后第1天及3天的认知功能,采用视觉模拟(VAS)评分评价2组患者术后苏醒时、苏醒后4、8、12及24 h时的疼痛程度;记录2组患者术后使用甘露醇的平均时间和剂量、比较不同时间点[手术前(T0)、吸氧面罩后(T1)、手术后8 h(T2)、12 h(T3)及24 h(T4)]动脉血二氧化碳分压(PaCO 2)及动脉血氧分压(PaO 2),记录术后并发症及疗效。结果:观察组患者术后第1天及3天的MMSE评分都高于对照组(P<0.05),2组患者术后4、8、12及24 h的VAS评分均降低(P<0.05);观察组患者的甘露醇应用时长和剂量均值均低于对照组(P<0.05);2组患者T0、T1、T2、T3及T4各时点PaCO 2和PaO 2比较差异均无统计学意义(P>0.05);观察组患者并发症发生率均低于对照组,且有效率高于对照组(P<0.05)。结论:开颅患者术后ICP监测不仅可以减少甘露醇的使用量及术后并发症的发生,还可改善患者临床预后、降低术后疼痛及改善认知功能。

Objective:To investigate the effects of mannitol application on pain,cognitive function,complications and efficacy of patients after craniotomy under the guidance of intracranial pressure(ICP)monitoring.Methods:A total of 115 patients undergoing craniotomy were randomly divided into an observation group(continuous ICP monitoring to guide the application of mannitol,n=65)and a control group(traditional application of mannitol in clinical observation,n=50);MMSE was used to evaluate the cognitive function of two groups of patients before and after operation.VAS was used to evaluate the pain of the two groups of patients after craniotomy.The total duration and dose of mannitol used in the two groups of patients,the PaCO 2 and PaO 2 were compared at different time points[before operation(T0),after oxygen mask(T1),after operation 8 h(T2),12 h(T3)and 24 h(T4)]and postoperative complications and efficacy were recorded.Results:The MMSE scores of the observation group were higher than those of the control group at 1 and 3 days after operation(P<0.05).The VAS scores of the observation group and the control group decreased at 4,8,12,and 24 hours after operation(P<0.05).The average duration and dosage of mannitol in the observation group were lower than those in the control group(P<0.05).There was no significant difference in PaCO 2 and PaO 2 between T0,T1,T2,T3,and T4 at all time points in the two groups(P>0.05).The incidence of complications in the observation group was lower than that in the control group,and the effective rate was higher than that in the control group(P<0.05).Conclusion:Postoperative ICP monitoring of craniotomy patients can not only reduce the amount of mannitol used and the incidence of postoperative complications but improve clinical prognosis,postoperative pain and cognitive function.