持续颅内压监测在SICU中sTBI儿童患者中的应用

Application of continuous intracranial pressure monitoring in children with sTBI in the SICU

目的探讨持续有创颅内压(ICP)监测在儿童外科重症监护室(SICU)中重型颅脑损伤(sTBI)患儿中的应用,为以后的临床诊疗提供经验。方法回顾性分析2017年1月—2019年12月南京医科大学附属儿童医院外科重症监护室收治的46例重型颅内损伤患儿,按照是否行有创颅内压监测分为监测组和对照组,其中监测组21例,对照组25例,记录两组患儿性别、年龄、体质量、格拉斯哥昏迷评分(GCS)、颅内出血类型、甘露醇使用量、钠代谢异常发生率、计算机断层扫描(CT)检查次数以及ICU住院时长,并进行分析。结果两组患儿在性别、年龄、体质量、GCS评分及颅内出血类型方面均无明显差别(P>0.05),监测组甘露醇使用量(4.43±2.63)g/kg,对照组甘露醇使用量(10.76±3.21)g/kg;钠代谢异常发生率,监测组为6/21(28.6%),对照组为15/25(60%);监测组患儿CT检查次数及ICU住院时间分别为(2.52±0.60)次和(7.28±1.9)d,对照组分别为(4.24±0.97)次和(10.44±3.18)d,两组患儿在甘露醇使用量、钠代谢异常发生率、CT检查次数及ICU住院时长的差别均有统计学意义(P<0.05)。结论颅内压监测作为一种监测手段,能通过指导临床诊疗而减少甘露醇使用量、影像学检查次数、钠代谢异常发生率及降低ICU住院日,对重型颅内损伤患儿的诊疗有益。

Objective To explore the application of continuous invasive intracranial pressure(ICP)monitoring in children with severe traumatic brain injury(sTBI)in the children's surgical intensive care unit(SICU).Methods The clinical data of 46 children with sTBI who were admitted to Surgical Intensive Care Unit,Children s Hospital Affiliated to Nanjing Medical University from January 2017 to December 2019 were analyzed retrospectively.They were divided into a monitoring group and a control group based on whether invasive ICP monitoring was performed,including 21 cases in the monitoring group and 25 cases in the control group.The gender,age,weight,Glasgow coma score(GCS),type of intracranial hemorrhage,mannitol consumption,incidence of abnormal sodium metabolism,number of computer tomography(CT)examinations and the length of ICU stay in the two groups were recorded and analyzed.Results There was no significant difference between gender,age,weight,GCS,and the type of intracranial hemorrhage of the two groups.The dosage of mannitol in the monitoring group was(4.43±2.63)g/kg and that in the control group was(10.76±3.21)g/kg.The incidence of abnormal sodium metabolism was 6/21(28.6%)in the monitoring group and 15/25(60%)in the control group.The distribution of CT examination times and ICU stay time in the monitoring group were(2.52±0.60)times and(7.28±1.9)days,and that in the control group were(4.24±0.97)times and(10.44±3.18)days respectively.There were statistically significant differences in mannitol use,incidence of abnormal sodium metabolism,CT examination times and ICU stay time between the two groups.Conclusions As a monitoring method,ICP monitoring can reduce the use of mannitol,the number of imaging examinations,the incidence of abnormal sodium metabolism and the length of stay in ICU by guiding clinical diagnosis and treatment,which is beneficial to the diagnosis and treatment of children with severe intracranial injury.