颅内压监测辅助开颅血肿清除术治疗颅脑损伤患者效果及其预后影响因素分析

Effect and Prognostic Factors of Intracranial Pressure Monitoring Assisted Removal of Craniotomy Hematoma in the Treatment of Patients with Craniocerebral Injury

目的:分析颅内压监测辅助开颅血肿清除术治疗颅脑损伤患者效果及其预后影响因素。方法:选择我院自2019年1月至2023年3月接诊的135例拟接受开颅血肿清除术治疗的颅脑损伤患者作为研究对象,根据监测方式不同,分为常规组和监测组;其中常规组予以标准开颅血肿清除术治疗,监测组予以颅内压监测下控制性减压结合开颅血肿清除术治疗。比较两组手术前后的颅内压、格拉斯哥昏迷(GCS)评分、手术并发症发生情况,根据术后90 d的格拉斯哥预后评分(GOS)评分,计算两组的预后良好率,使用单因素分析和多因素Logistic回归分析预后的影响因素。结果:监测组术后即刻及术后12h的颅内压均小于常规组(P<0.05);监测组术后24 h、48 h的GCS评分均高于常规组(P<0.05);监测组术中低血压、急性脑膨出、颅内血肿、脑血管痉挛和非计划性再次手术的发生率均低于常规组(P<0.05);经单因素分析和多因素Logistic回归分析,年龄、入院GCS评分、脑疝、改良CT图像评分均是颅脑损伤患者预后的独立影响因素(P<0.05)。结论:颅内压监测辅助开颅血肿清除术治疗颅脑损伤患者的效果显著,可以有效降低颅内压、减少并发症发生和改善预后,但预后受年龄、入院GCS评分、脑疝、改良CT图像评分的影响。

Objective:To analyze the effect and prognostic factors of intracranial pressure monitoring assisted removal of craniotomy hematoma in the treatment of patients with craniocerebral injury.Methods:135 patients with craniocerebral injury who were to be treated by craniotomy hematoma removal in our hospital from January 2019 to March 2023 were selected as study objects,and divided into conventional group and monitoring group according to different monitoring methods.The conventional group was treated with standard craniotomy hematoma removal,and the monitoring group was treated with controlled decompression under intracranial pressure monitoring combined with craniotomy hematoma removal.Intracranial pressure,Glasgow coma(GCS)score and postoperative complications were compared between the two groups before and after surgery.The good prognosis rate of the two groups was calculated according to the Glasgow prognosis score(GOS)90 days after surgery.Univariate analysis and multivariate Logistic regression were used to analyze the influencing factors of prognosis.Results:The intracranial pressure immediately and 12 h after operation in monitoring group was lower than that in conventional group(P<0.05).The GCS scores of the monitoring group at 24 h and 48 h were higher than those of the conventional group(P<0.05).The incidence of intraoperative hypotension,acute encephalocele,intracranial hematoma,cerebrovascular spasm and unplanned reoperation in monitoring group was lower than that in conventional group(P<0.05).Univariate analysis and multivariate Logistic regression analysis showed that age,admission GCS score,cerebral hernia score and modified CT image score were all independent influencing factors for prognosis of patients with craniocerebral injury(P<0.05).Conclusion:Intracranial pressure monitoring assisted craniotomy hematoma removal is effective in the treatment of patients with craniocerebral injury,which can effectively reduce intracranial pressure,reduce complications and improve prognosis,but the prognosis is affected by age,admission GCS score,brain hernia,and improved CT image score.