重度颅脑外伤患者术后监测颅内压及压力相关指数的临床价值

Clinical value of monitoring intracranial pressure and pressure related index in patients with severe traumatic brain injury after operation

目的:探讨监测颅内压及压力相关指数对重度颅脑外伤患者术后管理的指导价值。方法:纳入52例重度颅脑外伤[格拉斯哥昏迷评分(GCS)3~8分]术后机械通气患者并随机分成对照组和监测组,各26例。对照组给予常规监护和治疗,监测组在常规监护和治疗的基础上额外增加对颅内压及压力相关指数的监测。采用t检验或χ2检验比较两组患者撤机成功率、再插管率、再出血率、术后机械通气时间、甘露醇用量、继发性脑梗死发生率、肺部感染发生率、颅内感染发生率、治疗两周后GCS评分以及1个月后格拉斯哥预后评分(GOS)。结果:两组比较发现:与对照组相比,监测组在撤机成功率、再插管率、术后机械通气时间、甘露醇用量、继发性脑梗死发生率、术后肺部感染发生率、术后再出血率方面有明显改善(P<0.05);监测组治疗两周后的GCS评分及1个月后GOS评分明显高于对照组(P<0.05);两组患者术后颅内感染的发生率差异无统计学意义(P>0.05)。结论:监测颅内压及压力相关指数对重度颅脑外伤患者的术后管理和临床转归具有一定的临床应用价值。

Objective: To explore the guiding value of monitoring intracranial pressure and pressure-related indexes for postoperative management of patients with severe traumatic brain injury. Methods: Fifty-two patients with severe traumatic brain injury(GCS 3-8 points) postoperative mechanical ventilation were randomly divided into control group and monitoring group, 26 cases in each group. The control group was given routine monitoring and treatment, while the monitoring group was given additional monitoring of intracranial pressure and pressure-related indexes on the basis of routine monitoring and treatment. T-test or χ2 test was used to compare the success rate of weaning, reintubation rate, rebleeding rate, postoperative mechanical ventilation time, mannitol dosage, incidence of secondary cerebral infarction, incidence of pulmonary infection, incidence of intracranial infection, the GCS score after two weeks of treatment, and the Glasgow Outcome Score(GOS) one month later. Results: Compared with the control group, the success rate of weaning, reintubation rate, postoperative mechanical ventilation time, mannitol dosage, incidence of secondary cerebral infarction, incidence of postoperative pulmonary infection and postoperative rebleeding rate of the monitoring group were significantly improved(P<0.05);The GCS score after two weeks and the GOS score after one month in the monitoring group were significantly higher than those in the control group(P<0.05);There was no significant difference in the incidence of postoperative intracranial infection between the two groups(P> 0.05).Conclusion: Monitoring intracranial pressure and pressure-related index has a certain clinical application value for postoperative management and clinical outcome of patients with severe craniocerebral trauma.