持续有创颅内压监测在儿童重型颅脑创伤中的意义

目的：回顾性分析持续有创颅内压（ICP）监测对儿童重型颅脑创伤患者预后转归的影响。方法：对44例重型颅脑创伤术后的儿童采用持续有创ICP监测,按照预后评定标准（出院时病死率;哥拉斯哥预后评分）,观察其疗效。结果：ICP〈7.5 mmHg者（Ⅰ组）7例;ICP 7.5～20 mmHg者（Ⅱ组）18例;ICP 20～40 mmHg者（Ⅲ组）14例;ICP〉40 mmHg者（Ⅳ组）5例。12例患者在监测过程中发现ICP急骤升高,持续超过2 min,急诊复查CT发现颅内复发血肿或对侧颅内血肿,及时行二次手术治疗,其中8例发生于术后6 h内。出院时,Ⅰ组患者存活6例,死亡1例;Ⅱ组患者存活13例,死亡5例;Ⅲ组患者存活8例,死亡6例;Ⅳ组患者5例全部死亡。不同ICP患者病死率差异有统计学意义,P〈0.05。术后3 d内,存活者的平均ICP为（14.91±3.83）mmHg,死亡者的平均ICP为（27.16±5.62）mmHg,二者差异具有显著性意义,P〈0.01。伤后6个月时,不同ICP患者哥拉斯哥预后评分差异有显著性意义,P〈0.01。结论：对于重型颅脑创伤的儿童患者,持续有创ICP监测有助于客观评价创伤,及早发现病情变化,及时指导治疗,并可精确评估预后。

The significance of continuous invasive intracranial pressure monitoring in children with severe traumatic brain injury

Objective: To retrospectively analyze the impact of continuous invasive intracranial pressure(ICP) monitoring on the prognosis in children with severe traumatic brain injury.Methods: 44 children with severe traumatic brain injury after surgery were observed with continuous invasive ICP monitoring.According to prognostic assessment criteria(Discharge mortality;Glasgow outcome scale,GOS),the effects were evaluated.Results: There were ICP<7.5 mmHg(Ⅰ group) in 7 cases;ICP7.5～20 mmHg(Ⅱ group) in 18 cases;ICP20～40 mmHg(Ⅲ group) in 14 cases;and ICP>40 mmHg(Ⅳ group) in 5 cases.ICP in 12 cases increased rapidly during the monitoring process,lasting more than 2 min,reexamining of emergency CT revealed intracranial hematoma recurrence or contralateral intracranial hematoma,secondary surgical treatment was done in a timely manner,and including 8 cases occurred within 6 hours after surgery.When discharged,in Ⅰ group there were 6 cases survived,1 death;in Ⅱ group there were 13 cases survived,5 cases died;in Ⅲ group there were 8 cases survived,6 deaths;and in Ⅳ group 5 patients all died.The difference of mortality of patients with different ICP had statistical significance,P<0.05.Within 3 days after surgery,the mean ICP of survivors was(14.91±3.83) mmHg,while of the dead patients was(27.16±5.62) mmHg,the difference between the two was significant,P<0.01.6 months after injuried,the difference of GOS of patients with different ICP was significant,P<0.01.Conclusion: For children with severe head trauma,continuous invasive ICP monitoring is contribute to objective assessment of trauma,early detection of condition changes,timely guidance for treatment,and accurate assessment of prognosis.