重症颅脑损伤治疗中无创颅内压监测下控制性减压的应用研究

Research on application of controlled decompression under non-invasive intracranial pressure monitoring in the treatment of severe craniocerebral injury

目的研究重症颅脑损伤治疗中无创颅内压监测(NIICPM)下控制性减压的应用效果。方法选择2021年7月至2023年6月我院收治的SCI患者84例,依据随机数字表将患者分为无创组与有创组各42例,无创组行NIICPM,有创组行有创颅内压监测(IICPM)。观察两组术后1、3、7天颅内压;术前及术后7天昏迷程度、神经缺损情况及生活质量;术后7、30天脑血容量(CBV)、脑血流量(CBF)、达峰时间(TTP)及平均通过时间(MTT)等脑血流动力学指标;术前及术后7天血清纤维蛋白原样蛋白2(FGL2)、泛素C末端水解酶L1(UCH-L1)、晚期氧化蛋白产物(AOPP)等神经损伤相关因子水平;术后30天预后情况;术后并发症。结果术后1、3、7天两组颅内压差异无统计学意义(P>0.05);术后7天,无创组GCS评分、GQOL-74评分高于有创组,NIHSS评分低于有创组(P<0.05);术后7、30天,无创组CBV、CBF均大于有创组,TTP及MTT均小于有创组(P<0.05);术后7天,无创组血清FGL2、UCH-L1、AOPP水平均低于有创组(P<0.05);术后30天两组预后情况差异无统计学意义(P>0.05),无创组术后并发症发生率小于有创组(P<0.05)。结论NIICPM下控制性减压可稳定降低SCI患者颅内压,减轻神经损伤,避免脑血流动力学异常改变,减少术后并发症,改善患者预后,提高生活质量。

Objective To investigate the effect of controlled decompression under non-invasive intracranial pressure monitoring(NIICPM)in the treatment of severe craniocerebral injury(SCI).Methods Eighty-four patients with SCI admitted to our hospital from July 2021 to June 2023 were selected.The patients were divided into a non-invasive group and an invasive group using random number table method,42 in each group.NICPM was given to patients in the non-invasive group.The invasive group underwent invasive intracranial pressure monitoring(IICPM).The intracranial pressure of the patients after 1 day,3 and 7 days of operation was observed.The degree of coma,nerve defect and quality of life before and after 7 days of operation were also observed.Cerebral hemodynamic indexes such as cerebral blood volume(CBV),cerebral blood flow(CBF),time-to-peak(TTP),mean transit time(MTT)after 7 and 30 days of operation were recorded.The levels of serum nerve injury related factors such as fibrinogen-like protein 2(FGL2),ubiquitin carboxyl-terminal hydrolase isozyme L1(UCH-L1),advanced oxidation protein products(AOPP)were detected before and after7 days of operation.The prognosis after 30 days of operation and the postoperative complications in two groups were observed.Results There was no difference in intracranial pressure between the two groups after 1 day,3 and 7 days of operation(P>0.05).The Glasgow coma scale(GCS)score and Generic Quality of Life Inventory 74(GQOL-74)score in the non-invasive group was higher than those in the invasive group,and the NIHSS score was lower than that in the invasive group(P<0.05).The CBV and CBF in the non-invasive group were higher than those in the invasive group and the TTP and MTT in the non-invasive group were lower than those in the invasive group after 7 and 30 days of operation(P<0.05).The levels of serum FGL2,UCH-LI and AOPP in the non-invasive group were lower than those in the invasive group after 7 days of operation(P<0.05).There was no difference in prognosis between the two groups after 30 days of operation(P>0.05).The incidence of postoperative complications in the non-invasive group was lower than that in the invasive group(P<0.05).Conclusions Controled decompression under NIICPM can stably reduce the intracranial pressure in patients with SCI.It can alleviate the nerve injury,avoid the abnormal changes in cerebral hemodynamics,reduce the postoperative complications,and improve the prognosis and quality of life of the patients.