闪光视觉诱发电位在外伤性重型颅内出血术后患者颅内压监测中的价值

The value of flash visual evoked potentials for monitoring intracranial pressure in postoperative patients with traumatic severe intracranial hemorrhage

目的:探讨闪光视觉诱发电位(FVEP)对指导重症监护病房(ICU)外伤性重型颅内出血术后患者颅内压监测中的价值。方法:回顾性分析2016-2020年间因外伤性重型颅内出血术后收治在我院ICU的180例患者,根据是否采用FVEP监测随机分为观察组和对照组,其中观察组采用FVEP监测颅内压并据此指导脱水剂的使用,对照组根据患者症状、体征及头颅CT经验性使用脱水剂,记录并比较两组患者住院期间脱水剂使用时间、剂量以及急性肾损伤(AKI)的发生,同时比较两组患者出院时GCS评分、机械通气时间、ICU住院时间和28 d病死率。结果:与对照组比较,观察组脱水剂的使用时间显著缩短[(4.79±2.08)d vs.(6.13±3.71)d,P<0.05];使用总剂量显著减少[(322.26±131.21)g vs.(393.67±166.58)g,P<0.05];AKI发生率显著降低(7.52%vs.18.39%,P<0.05);随访两组预后,观察组出院时GCS评分显著提高(6.59±1.64 vs.5.77±1.48,P<0.05),机械通气时间[(5.27±1.87)d vs.(6.52±2.89)d,P<0.05]和ICU住院时间[(7.39±1.93)d vs.(8.48±3.09)d,P<0.05]均显著缩短,28 d病死率显著下降(11.83%vs.25.28%,P<0.05)。结论:FVEP可实现对颅内压的定量监测,可精细化指导外伤性重型颅内出血术后患者脱水剂使用,缩短机械通气时间和ICU住院时间,最终改善患者的预后。

Objective:To investigate the value of Flash Visual Evoked Potentials(FVEP)in guiding intracranial pressure monitoring in postoperative patients with traumatic severe intracranial hemorrhage in the Intensive Care Unit(ICU)Methods:A total of 180 patients with postoperative severe intracranial hemorrhage admitted to our ICU from 2016 to 2020 were retrospectively analyzed and divided into observation group and control group according to whether FVEP was used to monitor intracranial pressure.The FVEP noninvasive intracranial pressure monitoring method was used in the observation group to monitor intracranial pressure and adjust the use of dehydrating agents accordingly.While the use of dehydrating agents in the control group was empirically according to patients’symptoms,signs and cranial CT.The duration and dose of dehydrating agent usage,and the occurrence of acute renal injury during hospitalization were recorded and compared.The GCS scores,duration of mechanical ventilation,length of ICU stay and 28-day morbidity and mortality rates at discharge were also compared between the two groups.Results:Compared with the control group,the observation group had a significantly shorter duration of dehydration application[(4.79±2.08)d vs.(6.13±3.71)d,P<0.05],significantly lower dose[(322.26±131.21)g vs.(393.67±166.58)g],and significantly lower incidence of acute kidney injury(7.52%vs 18.39%,P<0.05).The GCS score at discharge was significantly higher in the observation group compared with that in the control group(6.59±1.64 vs.5.77±1.48,P<0.05).While in the observation group,the duration of mechanical ventilation[(5.27±1.87)d vs.(6.52±2.89)d,P<0.05]and ICU stay[(7.39±1.93)d vs.(8.48±3.09)d,P<0.05]were significantly reduced and the patient’s 28-day mortality was significantly decreased(11.83%vs.25.28%,P<0.05),compared with those in the control group.Conclusion:The FVEP method could achieve quantitative monitoring of intracranial pressure,which could finely guide the use of dehydrating agents in patients with severe intracranial hemorrhage,shorten the duration of mechanical ventilation and ICU stay,and ultimately improve the prognosis of patients.