脑室型颅内压监测在单侧颞叶脑挫裂伤治疗中的应用价值

Application value of ventricular intracranial pressure monitoring in the treatment of unilateral temporal lobe cerebral contusion

目的探讨脑室型颅内压监测(V-ICPM)在单侧颞叶脑挫裂伤治疗中的应用价值。方法采用回顾性队列研究分析2014年1月至2021年8月解放军联勤保障部队第九〇四医院收治的295例单侧颞叶脑挫裂伤患者临床资料,其中男172例,女123例;年龄14~78岁[(46.3±14.7)岁]。136例接受V-ICPM(V-ICPM组),根据监测情况行手术或非手术治疗;159例未接受V-ICPM(非V-ICPM组),行常规手术或非手术治疗。比较两组住院期间开颅清除颅内血肿、去骨瓣减压术(DC)、脱水渗透治疗的比率,质量分数20%甘露醇、30 g/L高渗盐使用时间,出院后病程中头颅CT脑中线结构移位≥10 mm、颅内感染、脑积水、癫痫发生的比率及出院后6个月格拉斯哥预后评分(GOS)。结果患者均获随访6~12个月[(8.9±2.1)个月]。住院期间V-ICPM组开颅清除颅内血肿比率为35.3%(48/136)、DC比率为8.1%(11/136),低于非V-ICPM组的47.2%(75/159)、22.0%(35/159)(P<0.05或0.01);两组脱水渗透治疗比率、甘露醇使用时间差异无统计学意义(P均>0.05);V-ICPM组高渗盐使用时间为(7.2±2.5)d,多于非V-ICPM组的(4.1±1.8)d(P<0.05)。出院后病程中V-ICPM组头颅CT脑中线结构移位比率为29.4%(40/136),低于非V-ICPM组的42.8%(68/159)(P<0.05);两组颅内感染、脑积水、癫痫发生的比率差异无统计学意义(P均>0.05)。出院后6个月V-ICPM组的GOS预后良好率为91.2%(124/136),明显优于非V-ICPM组的81.8%(130/159)(P<0.05)。结论对于单侧颞叶脑挫裂伤,V-ICPM可降低开颅探查及DC的比率,尽管增加了高渗盐使用时间,但不增加并发症发生率,并能有效改善患者预后。

Objective To explore the application value of ventricular intracranial pressure monitoring(V-ICPM)in the treatment of unilateral temporal lobe cerebral contusion.Methods A retrospective cohort study was conducted to analyze the clinical data of 295 patients with unilateral temporal lobe cerebral contusion admitted to 904th Hospital of PLA Joint Support Force from January 2014 to August 2021,including 172 males and 123 females;aged 14-78 years[(46.3±14.7)years].V-ICPM was used in 136 patients(V-ICPM group),who received surgical or non-surgical treatment according to the monitoring,while not in 159 patients(non-V-ICPM group),who received routine surgery or non-surgical treatment.The two groups were compared in terms of the rates of intracranial hematoma clearance by craniotomy,decompressive craniectomy(DC)and dehydration and osmotic therapy during hospitalization,use time of 20% mass fraction of mannitol and 30 g/L hypertonic salt,displacement rate of brain midline structure of head CT≥10 mm after discharge,rate of intracranial infection,hydrocephalus and epilepsy,and Glasgow Outcome Scale(GOS)at 6 months after discharge.Results All patients were followed up for 6-12 months[(8.9±2.1)months].During hospitalization,the rate of intracranial hematoma clearance by craniotomy and the rate of DC in V-ICPM group were 35.3%(48/136)and 8.1%(11/136),lower than 47.2%(75/159)and 22.0%(35/159)in non-V-ICPM group(P<0.05 or 0.01).There was no significant difference between the two groups in the rate of dehydration and osmotic therapy or the use time of mannitol(all P>0.05).The use time of hypertonic salt in V-ICPM group was(7.2±2.5)days,more than(4.1±1.8)days in non-V-ICPM group(P<0.05).After discharge,the displacement rate of brain midline structure of head CT in V-ICPM group was 29.4%(40/136),lower than 42.8%(68/159)in non-V-ICPM group(P<0.05).There was no significant difference between the two groups in the rate of intracranial infection,hydrocephalus and epilepsy(all P>0.05).Six months after discharge,the good rate of GOS in V-ICPM group was 91.2%(124/136),significantly better than 81.8%(130/159)in non-V-ICPM group(P<0.05).Conclusion For unilateral temporal lobe cerebral contusion,V-ICPM is associated with reduced rate of craniotomy exploration and DC,decreased incidence of complications and improved prognosis of the patients in spite of longer use time of hypertonic salt.