去骨瓣减压治疗重型颅脑损伤术中ICP的动态变化

目的探讨去骨瓣减压术(DC)治疗重型颅脑损伤中颅内压(ICP)的动态变化,分析减压前ICP与预后的相关性。方法回顾性分析35例重型颅脑损伤病人的临床资料,给予ICP探头植入后再行DC治疗。测定减压术前、去除骨瓣后、硬脑膜切开后、硬脑膜减张缝合后和关颅后的ICP,并于术后持续监测。出院时和伤后6个月以格拉斯哥预后评分(GOS)评估病人的预后,并分析减压术前ICP与预后的相关性。结果减压术前、骨瓣去除后、硬脑膜切开后、硬脑膜减张缝合后和关颅后的平均ICP分别为(42±12)mmHg、(26±6)mmHg、(6±3)mmHg、(8±5)mmHg和(12±7)mmHg。与减压术前相比较,骨瓣去除后和硬脑膜切开后ICP均明显下降(均P<0.001)。减压前ICP<40 mmHg组和ICP≥40 mmHg组在出院时和伤后6个月的预后良好率无显著差异(均P>0.05)。结论 DC治疗重型颅脑损伤时,硬脑膜广泛切开才能获得最大程度的ICP降低。

Dynamic changes of ICP during decompressive craniectomy in patients with severe traumatic brain injury

Objective To explore the dynamic changes of intracranial pressure（ICP） during decompressive craniectomy（DC） in patients with severe traumatic brain injury（TBI）,and analyze the correlation between preoperative ICP and prognosis.Methods Clinical data of 82 patients with severe TBI were analyzed retrospectively,who were treated by DC after the ICP probe implantation.The value of ICP before DC,after the removal of bone flap,after dural opening,after dural tension-reducing suture,after the closure of skull were measured and continuously monitored after DC.The prognosis was evaluated by glasgow outcome scale（GOS） at discharge and 6 months after injury.The correlation between preoperative ICP and prognosis was analyzed.Results The average values of ICP before DC,after the removal of bone flap,after the dural opening,after the dural tension-reducing suture and after the closure of skull were 42±12 mmHg,26±6 mmHg,6±3 mmHg,8±5 mmHg and 12±7 mmHg respectively.Compared with ICP before DC,ICP decreased significantly after the removal of bone flap and the dural opening（both P 0.001）.There was no significant difference in rates of good prognosis at discharge and 6 months after injury between group with preoperative ICP less than 40 mmHg and group with preoperative ICP equal to and more than 40 mmHg（both P 0.05）.Conclusions For the patients with severe TBI,extensive dural opening during DC is necessary to decrease ICP in the most effective manner.