中重度颅脑损伤患者治疗中结合有创动态颅内压监测的机制和临床价值

The mechanism and clinical value of invasive dynamic intracranial monitoring in the treatment of patients with moderate and severe craniocerebral injury

目的探讨中重度颅脑损伤患者治疗中结合有创动态颅内压监测的机制和临床价值。方法选取石家庄第三医院神经外科2017年4月-2018年4月收治的86例中重度颅脑损伤患者为研究对象,按照随机数字表法将其分为对照组(43例)和研究组(43例)。治疗过程中,对照组进行颅内压常规监测,研究组使进行有创动态颅内压监测。对比两组患者临床治疗效果、临床并发症发生率、不同时间段内的颅内压水平以及1w内脱水剂甘露醇用药状况以及GCS评分。结果研究组患者预后良好率为69.8%,对照组预后良好率为48.8%,对比显示研究组优于对照组(P<0.05);研究组患者临床并发症发生率为16.3%,对照组并发症发生率为62.8%,对比显示研究组并发症发生率更低(P<0.05);两组患者在术后20h,颅内压水平无显著区别(P>0.05),研究组患者术后40及60h血压水平优于对照组(P<0.05);研究组患者脱水剂甘露醇用药状况以及GCS评分均优于对照组(P<0.05)。结论中重度颅脑损伤患者治疗中结合有创态颅内压监测,能够对颅内压变化状况做到及时检测了解,便于第一时间实施颅内压降压治疗,利于患者预后,提升临床疗效,降低并发症的发生率。

Objective objective to explore the mechanism and clinical value of combined invasive dynamic intracranial monitoring in the treatment of patients with moderate and severe craniocerebral injury.Methods 86 patients with moderate and severe craniocerebral injury admitted to our hospital from April 2017 to April 2018 were selected as study objects,which were divided into control group(43 cases)and research group(43 cases)according to the random number table.During the treatment,the control group was routinely monitored for intracranial pressure,while the study group was monitored for invasive and dynamic intracranial pressure.The clinical treatment effect,the incidence of clinical complications,the intracranial pressure level at different time periods,and the treatment status of the dehydrant mannitol and the GCS score were compared between the two groups.Results the good prognosis rate of the study group was 69.8%and that of the control group was 48.8%,showing that the study group was superior to the control group(P<0.05).Clinical complication rate was 16.3%in the study group and 62.8%in the control group,showing a lower complication rate in the study group(P<0.05).There was no significant difference in intracranial pressure level between the two groups 20 hours after surgery(P>0.05),and the blood pressure level of the study group 40 and 60 hours after surgery was better than that of the control group(P<0.05).The results of mannitol and GCS in the study group were better than those in the control group(P<0.05).Conclusions combined with invasive and dynamic intracranial monitoring in the treatment of patients with moderate and severe craniocerebral injury,it can timely detect and understand the changes of intracranial pressure,facilitate the timely implementation of intracranial pressure drop therapy,and is conducive to the prognosis of patients,improving clinical efficacy and reducing the incidence of complications.