超声动态监测在神经重症去骨瓣减压患者救治中的应用效果

Application effect of ultrasonic dynamic monitoring in the treatment of critically-ill neurological patients with decompressive craniectomy

目的 观察超声动态监测在神经重症去骨瓣减压患者救治中的应用效果。方法 选取2021年3月~2022年12月收治的在救治中以超声动态监测的神经重症去骨瓣减压患者30例作为研究组,另选取2018年1月~2021年2月收治的在救治中以常规监测的神经重症去骨瓣减压患者30例作为对照组。比较两组患者术后不同时间的颅内压、格拉斯哥昏迷评分(GCS),术后脑疝发生率、再出血率及死亡率。结果 研究组患者术后12、24、36、48 h的颅内压分别为(23.43±4.35)、(19.61±3.52)、(17.37±2.01)、(16.72±1.27)mm Hg(1 mm Hg=0.133 kPa),GCS评分分别为(2.17±0.46)、(3.98±0.52)、(4.47±0.61)、(5.19±0.18)分;对照组患者术后12、24、36、48 h的颅内压分别为(23.48±4.46)、(21.43±3.37)、(20.85±3.26)、(19.46±2.25)mm Hg,GCS评分分别为(2.23±0.32)、(3.23±0.67)、(4.05±0.46)、(4.55±0.37)分。两组患者术后12 h的颅内压、GCS评分比较,差异无统计学意义(P>0.05);两组患者术后24、36、48 h的颅内压低于本组术后12 h,且研究组低于对照组;两组患者术后24、36、48 h的GCS评分高于本组术后12 h,且研究组高于对照组;差异均有统计学意义(P<0.05)。术后,研究组患者的脑疝发生率0、再出血率3.33%、死亡率3.33%均低于对照组的20.00%、30.00%、26.67%,差异具有统计学意义(P<0.05)。结论 超声动态监测应用于神经重症去骨瓣减压患者救治中,对于改善患者术后颅内压水平,减轻昏迷严重程度,降低术后脑疝发生率、再出血率及死亡率具有较高的临床意义。

Objective To observe the application effect of ultrasonic dynamic monitoring in the treatment of critically-ill neurological patients with decompressive craniectomy.Methods 30 cases of criticallyill neurological patients with decompressive craniectomy who received ultrasonic dynamic monitoring during treatment from March 2021 to December 2022 were selected as the research group,and 30 cases of criticallyill neurological patients with decompressive craniectomy who received routine monitoring during treatment from January 2018 to February 2021 were selected as the control group.The intracranial pressure and Glasgow coma scale(GCS)score at different time after surgery,incidence of postoperative cerebral hernia,rebleeding rate,and mortality rate were compared between the two groups.Results The intracranial pressure of patients in the research group at 12,24,36,and 48 h postoperatively were(23.43±4.35),(19.61±3.52),(17.37±2.01),and(16.72±1.27)mm Hg(1 mm Hg=0.133 kPa),and the GCS scores were(2.17±0.46),(3.98±0.52),(4.47±0.61),and(5.19±0.18)points.The intracranial pressure in the control group at 12,24,36,and 48 h postoperatively were(23.48±4.46),(21.43±3.37),(20.85±3.26),and(19.46±2.25)mm Hg,and the GCS scores were(2.23±0.32),(3.23±0.67),(4.05±0.46),and(4.55±0.37)points.The differences in intracranial pressure and GCS scores at 12 h postoperatively between the two groups were not statistically significant(P>0.05).The intracranial pressure in both groups at 24,36 and 48 h postoperatively was lower than that at 12 h postoperatively in this group,and the resesarch group was lower than the control group;GCS scores in both groups at 24,36 and 48 h postoperatively were higher than that at 12 h postoperatively in this group,and the research group was higher than the control group;the differences were statistically significant(P<0.05).Postoperatively,the incidences of brain herniation,rebleeding rate,and mortality rate in the research group were 0,3.33%,and 3.33%,which were lower than those of 20.00%,30.00%,and 26.67%in the control group,and the differences were statistically significant(P<0.05).Conclusion Application of ultrasonic dynamic monitoring in critically-ill neurological patients with decompressive craniectomy is of great significance for improving the postoperative intracranial pressure,reducing the severity of coma,and decreasing the incidence of postoperative cerebral hernia,rebleeding rate and mortality rate.