有创颅内压监测用于重型颅脑创伤去骨瓣减压术中的价值

The Value of Invasive Intracranial Pressure Monitoring in Decompressive Craniectomy for Severe Traumatic Brain Injury

【目的】探讨有创颅内压监测用于重型颅脑创伤(sTBI)去骨瓣减压术的价值。【方法】选取2018年7月至2021年7月本院收治的78例行去骨瓣减压术的sTBI患者,以随机数字表法分为观察组与对照组,每组39例。对照组行去骨瓣减压术,观察组在去骨瓣减压术的同时使用有创颅内压监测。比较两组临床疗效及术后并发症、神经重症监护室(NICU)住院时间、甘露醇用量、甘露醇使用时间、术前及术后不同时点颅内压,手术前后生化指标[白介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、神经元特异性烯醇化酶(NSE)]水平。【结果】观察组预后良好率显著高于对照组,差异有统计学意义(P<0.05)。观察组NICU住院时间、甘露醇用量、甘露醇使用时间显著少于对照组,差异有统计学意义(P<0.05)。两组患者术后1 d、3 d、7 d颅内压低于术前,差异有统计学意义(P<0.05);观察组术后3 d、7 d颅内压低于对照组,差异有统计学意义(P<0.05)。术后,两组血清IL-6、hs-CRP、TNF-α、NSE水平低于术前,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组术后并发症总发生率低于对照组,差异有统计学意义(P<0.05)。【结论】有创颅内压监测用于sTBI患者去骨瓣减压术中可有效缩短NICU住院时间,减少甘露醇用量,恢复颅内压,显著改善患者神经功能及预后。

【Objective】To explore the value of invasive Intracranial pressure monitoring in decompressive craniectomy for severe traumatic brain injury(sTBI).【Methods】A total of 78 sTBI patients who underwent decompressive craniectomy in our hospital from July 2018 to July 2021 were selected and randomly divided into an observation group and a control group,with 39 patients in each group.The control group received decompressive craniectomy,and the observation group used invasive Intracranial pressure monitoring while decompressive craniectomy.The clinical efficacy and postoperative complications of the two groups were compared,including the length of stay in the NICU,the amount of Mannitol,the use time of Mannitol,Intracranial pressure at different time points before and after surgery,and biochemical indicators before and after surgery[interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),neuron specific Enolase(NSE)].【Results】The good prognosis rate of the observation group was significantly higher than that of the control group,and the difference was statistically significant(P<0.05).The NICU hospitalization time,Mannitol dosage and Mannitol use time in the observation group were significantly shorter than those in the control group(P<0.05).The intracranial pressure of patients in the two groups was lower than that before operation on the 1st,3rd and 7th days after operation,with a statistically significant difference(P<0.05);The intracranial pressure of the observation group was lower than that of the control group 3 days and 7 days after operation,with a statistically significant difference(P<0.05).After surgery,two groups of serum IL-6,hs-CRP,TNF-α,the NSE level was lower than those before surgery,and the observation group was lower than the control group,with a statistically significant difference(P<0.05).The total incidence of postoperative complications in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).【Conclusions】The use of invasive Intracranial pressure monitoring in decompressive craniectomy for sTBI patients can effectively shorten the hospital stay of NICU,reduce the dosage of Mannitol,restore Intracranial pressure,and significantly improve the neurological function and prognosis of patients.