颅内压监护在急性中型颅脑损伤患者治疗中的意义

目的研究原发性急性中型颅脑损伤患者行颅内压(ICP)监测对临床诊治的意义。方法71例伤后24h内入院的原发性急性中型颅脑损伤患者,入院时均行头部CT检查无手术指征,将其随机分为ICP监护治疗组(35例):入院后即采用目前国际上通用的脑室内穿刺置管法行ICP持续监护,用美国产Marquette监护仪进行4 ~ 7 d连续监测;常规治疗组(36例):进行包括脱水、止血、防治上消化道出血等治疗,监测生命征、意识的改变及血、尿等常规和生化指标,必要时对治疗方案作出调整。结果ICP监护治疗组出现3例ICP>40 mmHg或入院后ICP很快进行性增高,行CT检查发现迟发性颅内血肿或原位血肿增大、中线明显移位,即手术治疗。术后1例重残,1例中残,1例轻残;另有5例患者ICP监护中发现达中度增高(20 ~ 40 mmHg),CT检查提示仅为脑水肿加重,不具手术指征,经调整脱水药剂量,间断开放脑室外引流后病情平稳好转。结论中型颅脑损伤伤后病情不稳定,行ICP监测能及早发现病情变化,可降低致残率和死亡率,有效提高疗效,改善预后。

Application of intracranial pressure monitoring in diagnosis and treatment of acute moderate primary traumatic brain injury

Objective To study the significance of intracranial pressure (ICP) monitoring in diagnosis and treatment of acute moderate primary traumatic brain injury. Methods71 patients of acute moderate primary traumatic brain injury admitted within 24 hours after being injured without indication of operation by CT scanning were divided into ICP monitoring group and routine group. 35 patients in ICP monitoring group received continuous ICP monitoring for 4-7days with Marquette poly-parameter monitor for adjusting treatment project. 36 patients in routine group were treated with dehydration, hemostasia, preventing and curing ulceration of upper alimentary tract, monitoring vital sign and consciousness and making routine and biochemical test of blood and urine. Results In ICP monitoring group, ICP of 3 cases exceeded 40 mmHg or increased continuously after admission were found with delated intracranial hematoma, enlarged hematoma at original site or midline shifting significantly by CT scanning, They were treated surgically in time. After operation, mild, moderate and severe disabilities each occurred upon 1 case. There was moderate increasing of ICP (20-40 mmHg) in another 5 patients found with no operaive indication but brain edema aggravating by CT scanning. After being treating by adjusting the doses of dehydration and interruptedly opening the external drainage of CSF, they got rehabilitated placidly. Conclusion Initially, the state of acute moderate primary traumatic brain injury is unstable. ICP monitoring can help find the changes of symptoms, therefore decreasing the morbidity and mortality and improving curative effect and prognosis.