重型创伤性脑损伤去骨瓣减压应用改良Paine点穿刺监测脑室内颅内压的优势

Advantages of intraventrilular intracranial pressure monitoring with modified paine point puncture in decompression of severe traumatic brain injury

目的探讨重型创伤性脑损伤(TBI)开颅去骨瓣减压术(DC)中应用改良Paine点穿刺行脑室内颅内压(ICP)监测探头置入的优势。方法回顾性分析2020年4月-2022年4月嘉兴市第二医院收治的48例重型TBI患者的临床资料。所有患者均行DC联合脑室内ICP监护术,按照ICP监测术式的不同,分为观察组(23例)与对照组(25例),其中观察组行DC切口内改良Paine点穿刺脑室内ICP监测探头置入术,对照组行传统DC对侧切口颅骨钻孔经Kocher点脑室内ICP监测探头置入术。比较两组术前一般资料、手术用时、术后甘露醇使用剂量及持续时间、ICP监测持续时间、术后再出血率、颅内感染率、术后3个月时格拉斯哥预后评分(GOS)。结果两组一般资料、甘露醇使用剂量、甘露醇持续时间和ICP监测持续时间比较差异均无统计学意义(P>0.05);观察组手术用时、术后再出血率、颅内感染率明显少于或低于对照组(P<0.05);两组术后3个月GOS评分比较差异无统计学意义(P>0.05)。结论相较传统的DC对侧切口颅骨钻孔经Kocher点行脑室内ICP监测探头置入术,重型脑外伤DC术中通过切口内改良Paine点穿刺行脑室内ICP监测探头置入术可缩短手术用时,降低术后再出血率、颅内感染率。

Objective To explore the advantages of modified Paine point puncture for intraventricular intracranial pressure(ICP)monitoring probe implantation during decompressive craniectomy(DC)for severe traumatic brain injury.Methods The clinical data of 48 patients with severe traumatic brain injury admitted from April 2020 to April 2022 in Jiaxing Second Hospital were retrospectively collected.All patients underwent DC combined with ICP monitoring probe implantation.According to different ICP monitoring methods,they were divided into observation group(23 cases)and control group(25 cases).The observation group underwent the implantation of the intracerebroventricular ICP monitoring probe by puncture at the modified Paine point in the DC incision,while the control group underwent implantation of intracerebroventricular ICP monitoring probe by drilling of the skull through contralateral incision of DC at the Kocher point.The preoperative general data,operation time,postoperative mannitol dose and duration,ICP monitoring duration,postoperative rebleeding rate,intracranial infection rate and Glasgow outcome score(GOS)at 3 months after the operation were compared between the two groups.Results There was no statistical difference between the two groups in general data,mannitol dosage,mannitol duration and ICP monitoring duration(P>0.05).The operation time,postoperative rebleeding rate and intracranial infection rate in observation group were lower than those in control group(P<0.05).In the GOS score at 3 months after the operation,there was no statistical difference between the two groups(P>0.05).Conclusions Compared with the traditional implantation of intraventricular ICP monitoring probe through Kocher point through skull drilling with contralateral incision of DC,the implantation of intraventricular ICP monitoring probe through modified Paine point in the DC incision for severe traumatic brain injury can shorten the operation time and lower the postoperative rebleeding rate and intracranial infection rate.