住院期间TCD监测下强化管理方案对重型颅脑损伤术后患者远期疗效的影响研究

Long-term effect of strengthening management under transcranial Doppler monitoring on patients with severe craniocerebral injury during hospitalization

目的探讨住院期间经颅多普勒超声(TCD)监测下强化管理方案对重型颅脑损伤术后患者远期疗效的影响。方法依据随机平行对照的临床试验方案,将自2016年6月至2019年12月收治于咸阳市第一人民医院神经外科一病区及神经重症监护病房的84例、潍坊市临朐县中医院外三科的12例,潍坊市临朐县人民医院脑外一科的10例共106例重型颅脑损伤术后患者按随机数字表法分为对照组和观察组,每组53例。术后住院期间,对照组实施《重型颅脑损伤救疗指南第4版》中的常规管理方案;观察组则在对照组方案的基础上,每天应用TCD监测大脑中动脉及颈内动脉颅外段,记录或计算血压、收缩期峰流速、舒张末期流速,血管阻力指数及平均动脉压、无创脑灌注压、脑血管阻力、无创颅内压、Lindegard指数等监测指标.并结合监测指标制定、实施个体化的强化管理方案。对比分析2组患者间平均住院日、住院期间硬膜下积液发生比例以及伤后6个月格拉斯哥预后扩展量表(GOSE)评分的差异。结果观察组患者的平均住院日[(20.7±4.2)d]、住院期间硬膜下积液发生比例(9.4%)均明显低于对照组[(28.2±4.4)d.20.7%],伤后6个月GOES评分[(5.5±1.2)分]明显高于对照组[(3.2±0.9)分],差异均有统计学意义(P<0.05)。结论住院期间TCD监测下制定的强化管理方案可以更有效地改善重型颅脑损伤术后患者的远期预后。

Objective To investigate the long-term influence of strengthening management under transcranial Doppler(TCD)monitoring in prognosis of patients with severe craniocerebral injury during hospitalization.Methods According to the randomized parallel controlled clinical trial,from June 2016 to December 2019.84 patients from first Ward and Neurological Intensive Care Unit of Department of Neurosurgery,Xianyang First People's Hospital,12 patients from Third Surgical Department.Chinese Medicine Hospital of Linqu County,and 10 patients from First Brain Surgical Department,Chinese Medicine Hospital of Linqu County were randomly divided into control group and observation group(n=53).Patients in the control group used postoperative management plan proposed by BTF Guidelines for Severe Traumatic Brain Injury(4^(th)Edition),and patients in the observation group accepted strengthening management plan formulated by our research group on the basis of treatment in the control group:TCD monitoring of middle cerebral artery and extracranial internal carotid artery was daily used to record or calculate blood pressure,systolic peak velocity,end-diastolic velocity,vascular resistance index,mean arterial pressure,noninvasivc cerebral perfusion pressure,cerebral vascular resistance,noninvasive intracranial pressure,and Lindegaard index;and individualized strengthening management was given according to the monitoring indicators.The average length of hospitalization,proportion of subdural effusion during hospitalization,and Glasgow outcome scale-extended(GOSE)scores at 6 months after injury were compared between the two groups.Results The average length of hospitalization([20.7±4.2]d)and proportion of subdural effusion during hospitalization(9.4%)in the observation group were significantly lower than those in the control group([28.2±4.4]d,20.7%,P<0.05).The GOSE scores at 6 months after injury(5.5±1.2)were significantly higher than those in the control group(3.2±0.9,P<0.05).Conclusion Strengthening management under TCD monitoring during hospitalization can more effectively improve the long-term prognosis of patients with severe craniocerebral injury.