颅脑损伤后的颅内压监测

颅内压监测技术在国内外神经外科被广泛应用,其监测方法也在不断改进,重点介绍传播器连续颅内监测中的应用方法。     

颅内压监测在颅脑损伤患者中的应用与护理

目的探讨经颅内引流管行颅内压（ICP）监测对颅脑损伤疾病治疗的应用价值与护理。方法对2009年2月至2011年1月入住ICU的因颅脑损伤已行颅内引流术的患者,在常规监护、治疗基础上,在颅内引流管外侧端接三通管,行ICP监测。对ICP〉2.0 kPa者予加强脱水,ICP〈0.5 kPa者提高引流袋水平,减少脱水剂用量及使用时间。结果共53例患者行ICP监测,死亡6例,死亡率11.32%;较同期未行ICP监测病例死亡率26.53%明显下降。监测结果及表现图谱与病程发展相符。结论颅脑损伤术后患者经颅内引流管行ICP监测操作简便,达到ICP监测技术要求,具有明显的临床意义。     

颅内压监测在颅脑损伤中的应用进展

颅脑损伤患者往往伴随着不同程度的颅内压(intracranial pressure, ICP)增高,ICP增高又是造成各种临床症状和不良预后的重要病理生理因素。临床上对创伤性颅脑损伤患者进行及时且有效的ICP监测能更及时准确地为临床治疗提供依据,利于患者预后。面对不同程度的颅脑损伤患者,选择合适的ICP监测工具有利于病情监测,减少患者痛苦。本文针对目前有创和无创ICP监测方式在颅脑损伤患者中的应用进展进行了全面的回顾和阐述,探讨临床无创监测ICP手段的发展方向和应用前景。     

脑室内颅内压监测在急性重型颅脑损伤中的应用

目的:研究颅内压(ICP)监测对重型颅脑损伤患者的作用.方法:从2007年1月至2010年2月共收治243例重度颅脑损伤患者.常规植入脑室内探头,连续测量颅内压4-15 d.结果:根据损伤后6个月COS评估预后,109例(44.8%)恢复良好,57例(23.5%)中度残疾,39例(16.0%)严重残疾,17例(6.9%)植物状态,21例(8.6%)死亡.结论:脑室内ICP监测在重型颅脑损伤患者管理中发挥了重要作用.     

颅内压监测在中度颅脑损伤中的应用及护理

判断颅脑损伤的一个主要客观指标是颅内压(ICP)水平,通过对颅内压的监测了解ICP的动态变化,同时监测血压可以间接了解脑灌汽压(CPP)水平,从而判断病情演变,早期给予干预。我院2003年6月~2006年6月,对46例中度颅脑损伤病人均行颅内压监测取得较好效果,报告如下。1资料与方法1.1一般资料本组46例,男32例,女14例,年龄14~57岁,平均39.2±11,3岁,其中急性硬膜下血肿(A)12例,硬膜外血肿(B)18例,脑挫伤和原发脑干损伤(C)16例。对照组在2000年6月~2003年5月发病例数、年龄、性别及出血部位上均差异无显著意义(P>0.05),两组资料具有可比性。表1…     

颅脑损伤后的颅内压监测

颅内压监测技术在国内外神经外科被广泛应用,其监测方法也在不断改进,重点介绍传感器在连续颅内压监测中的应用方法。     

光导纤维传感器在急性颅脑损伤患者颅内压监测中的应用

我们自１９９５年１０月～１９９７年１０月应用光导纤维传感器（光纤探头）对４２例急性颅脑损伤术后患者行硬脑膜外颅内压（ＩＣＰ）监测,报告如下。１病例与方法１．１病例：４２例急性颅脑损伤患者中,男３２例,女１０例;年龄１４～５６岁,平均３４．６岁。急性硬...     

颅内压监测在颅脑损伤患者治疗中的应用研究

目的 及时发现、处理颅脑损伤患者的颅内高压,降低临床死亡率.方法 将85例颅脑损伤、颅内引流术后的患者按入院的时间分为对照组30例和观察组55例.对照组采用常规的方法观察患者的意识、瞳孔、生命体征变化,对血压突发增高、瞳孔改变、呼吸不规则等提示颅内压增高的患者给予加强脱水治疗.对观察组患者均进行颅内压(ICP)监测,对ICP＞2.0 kPa者给予加强脱水治疗,比较2组患者的好转率.结果 对照组,死亡12例,观察组,死亡7例.2组死亡率比较差异有统计学意义(P＜0.05).结论 ICP监测准确、可靠,较传统的观察法能更及时的发现病情变化,减少治疗的盲目性,降低颅脑损伤患者的死亡率.     

持续颅内压监测在重症颅脑损伤中的应用及护理

颅内压（ICP）增高是很多颅脑疾病共有的综合征,也是神经外科疾病造成死亡的重要原因。其持续性增高可降低脑血流,导致脑供血不足,形成脑缺血、缺氧,甚至发生急性脑肿胀而引发死亡,严重威胁患者生命。ICP监测操作简单,创伤小,且测压准确,是监护ICP最有效的方法。因此,持续ICP监测可动态观察颅脑术后患者ICP的变化,及时发现异常并进行处理,从而提高救治水平,对重症颅内损伤患者具有重要临床意义。本研究对重症颅内损伤患者进行持续ICP监测,并配合相应护理措施,取得了良好疗效,现将其应用及护理体会报告如下。     

持续颅内压监测在重型颅脑损伤患者治疗中的应用

目的探讨持续动态颅内压监测在重型颅脑损伤患者治疗中的应用价值。方法回顾分析2012年1月至2013年12月收治的106例颅脑损伤患者的临床资料,53例行有创颅内压监测者为监测组,53例未行颅内压监测者为非监测组,比较两组的临床疗效、并发症和格拉斯哥预后分级评分(GOS)。结果监测组患者电解质紊乱发生率为9.4%,消化道出血发生率为11.3%,均明显低于非监测组(24.5%,32.1%,P均<0.05)。监测组预后良好率为77.4%,明显高于对照组的49.1%(P<0.01)。与非监测组比较,监测组甘露醇应用时间、应用剂量均明显减少(P均<0.01)。结论对重型颅脑损伤患者进行持续颅内压监测,可准确反映患者病情变化,为颅脑损伤患者的正确治疗及预后判断提供重要的参考依据。     

持续颅内压监护在重型颅脑损伤中的应用

目的 探讨颅内压持续动态监护在重型颅脑损伤救治中的指导意义.方法 将我院2004年8月至2011年2月收治的124例重型颅脑损伤患者随机分为颅内压监护组(62例)和常规治疗组(62例).颅内压监护组根据颅内压的变化随时调整治疗方案,常规治疗组凭经验进行常规的神经外科治疗.结果 颅内压监护组并发急性肾功能衰竭7例,电解质紊乱11例;常规治疗组并发急性肾功能衰竭15例,电解质紊乱25例.颅内压监护组并发症发生率低(x2值为分别为3.54,7.67,P均<0.01).颅内压监护组及常规治疗组甘露醇使用时间分别为(6±2)、(15±3)d,使用剂量分别为(749±125)、(1545±250)g;恢复良好和轻残分别为28、16例,13、9例;重残、植物生存及死亡分别为9、17例,4、7例,8、13例;颅内压监护组较常规治疗组甘露醇使用时间短、剂量小(t值分别为8.32,7.41,P均<0.01),恢复良好和轻残比例高(x2值分别为5.07,3.55,P均<0.01),而重残、植物生存及死亡比例低(x2值分别为0.84,0.89,1.43,P均<0.01).结论 持续颅内压监护有利于早期指导和及时调整治疗措施,降低并发症,改善预后.

Abstract：

Objective To discuss the meaning of continuous intracranial pressure (ICP) monitoring in patients with severe traumatic craniocerebral injury. Methods One hundred and twenty four patients with severe craniocerebral injury treated from August 2004 to February 2011 in our hospital, were enrolled and divided randomly into ICP monitoring group (n = 62) and routine treatment group (n = 62). The patients of ICP monitoring group had adjusted treatment plan according to the changes of ICP at any time, whereas the patients in routine treatment group underwent routine neurosurgical treatment according to the doctors' experience. Results There were 7 cases of acute kidney function failure,and 11 cases of electrolyte disturbances in the ICP group.There were 15 cases of acute kidney function failure, and 25 cases of electrolyte disturbances in the routine group. The complication rate in the ICP group was lower than that in the routine group (x2 =3. 54 and 7.67 for acute kidney function failure and electrolyte disturbances respectively, Ps <0. 01). The days of mannite using were (6±2)dand (15 ±3)d, respectively; the dosage of mannite using were (749 ± 125) g and (1545 ±250) g,respectively. The good recovery and slight disability were 28 and 16 cases in the ICP group, and 13 and 9 cases in the routine group,respectively. The severe disability,vegetative state and death were 9,4 and 8 cases in the ICP group,and 17,7 and 13 cases in the routine group. The days and dosage of mannite using in the ICP group were much less than those in the routine group (t = 8. 32 and 7.41, Ps < 0. 01). The proportion of good recovery and slight disability in the ICP group were higher than those in the routine group(x2 =5. 07 and 3. 55,Ps <0.01). However, the proportion of severe disability, vegetative state and death in the ICP group were lower than those in the routine group (x2 =0.84,0.89 and 1.43, Ps < 0. 01) . Conclusion Continuous ICP monitoring in severe craniocerebral injury shows benefits in directing treatment plan adjustment, reducing complications and improving the prognosis.     

Intracranial pressure monitoring and assessing intracranial compliance in brain injury

Caring for the patient with a brain injury is a dynamic process with the goal of providing therapy to prevent secondary injury. Until practitioners have a better understanding of the pathophysiology of ischemia and the response of therapies for treating increased ICP, they must use the tools that exist. ICP monitoring gives a rough index of the relationships and the response of the intracranial contents to changes in volume that may produce increases in pressure and further damage. Understanding the information supplied by ICP monitoring is imperative to successful management of increased ICP.     

有创颅内压监测在重型颅脑损伤患者术后治疗中的价值

目的探讨有创颅内压监测在重型颅脑损伤患者术后治疗中的临床应用价值。方法选择2011年3月至2014年3月在武警浙江总队杭州医院进行诊治的74例重型颅脑损伤患者作为研究对象,所有患者术后均行颅内压监测,并分为观察组和对照组各37例。观察组采用Codman颅内压监护仪进行有创颅内压监测,对照组采用闪光视觉诱发电位进行无创颅内压监测。依据所测颅内压的动态变化调整甘露醇使用剂量及时间,必要时复查头颅CT检查并行相应处置。结果观察组术后72、120h颅内压水平低于对照组,差异有统计学意义(t=-2.39、-5.41,P0.05)。观察组甘露醇平均应用时间及剂量低于对照组,差异有统计学意义(t=-18.80、-22.50,P0.05)。观察组格拉斯哥预后评分(GOS评分)预后良好的比例高于对照组,差异无统计学意义(χ~2=0.216,P0.05)。结论有创颅内压监测能准确反映重型颅脑损伤患者术后颅内压变化情况,有助于指导临床用药。     

脑氧分压与颅内压联合监测在指导重型颅脑损伤治疗中的应用价值

目的：探讨脑氧分压联合颅内压监测在重型颅脑损伤患者治疗中的指导作用。方法收集84例重型颅脑损伤的患者随机分为A、B、C 3个组,每组28例,分别给予单独脑氧分压监测、单独颅内压监测和脑氧分压联合颅内压监测,分别统计3个组患者入院时和治疗72 h后的脑氧分压值、治疗1周内的甘露醇应用总量、格拉斯哥预后（GOS ）评分各等级的病例数进行对比。结果 A组和C组治疗后脑氧分压值的上升水平明显高于B组,差异有统计学意义（P＜0．05）;B组和C组治疗1周内应用甘露醇的总量明显少于 A组,差异有统计学意义（P＜0．05）;C组患者治疗后3个月恢复良好的11例,明显多于 A 组的4例和B组的3例,差异有统计学意义（ P＜0．05）;C组无死亡患者,明显少于A组的4例和B组的5例,差异有统计学意义（P＜0．05）。结论行脑氧分压联合颅内压监测既可及时有效地指导纠正脑缺血缺氧情况,又可正确地指导脱水剂的应用,在重型颅脑损伤患者的治疗中具有良好的效果和重要的价值。     

Intracranial hypertension. Advances in intracranial pressure monitoring

Research is continuing to find improved methods for monitoring intracranial pressure as well as the effect of intracranial hypertension on the patient's recovery. Each of the methods of monitoring has its advantages and disadvantages and the use of one method over others is usually the preference of the neurosurgeon. It is the responsibility of the nurse to be aware of the strengths and weaknesses of each device in order to strengthen patient outcome. Again, the major benefits of the bolt are a low infection rate and easy insertion. Problems associated with its use of which the nurse should be aware are a tendency for a dampened waveform that gives an inaccurate pressure reading requiring irrigation that may or may not clear the catheter, and the inaccurate readings given by the bolt at high pressures. The subdural catheter can be used for long-term monitoring; however, baseline drift has been reported. Ventricular catheters have a mixed bag of results according to research. They are the most accurate of the methods used and enable cerebrospinal fluid to be drained, thereby lowering ICP. However, the catheters appear to have a higher infection rate. This is debatable, however. Some researchers advocate the prophylactic use of antibiotics. A closed drainage system should be used and if the device is used for longer than 4 days, the device should be changed and care should be taken to prevent leakage of cerebrospinal fluid. The devices currently in use have been presented and patient outcomes discussed using medical research, as none was available from the nursing literature.(ABSTRACT TRUNCATED AT 250 WORDS)     

重型颅脑损伤时血糖水平与颅内压及预后的关系

目的:探讨严重颅脑损伤患者血糖水平与病情严重程度及颅内压和预后的关系。方法:第四军医大学唐都医院2001-09/2003-08神经外科收治284例严重颅脑损伤患者,发病后12h内入院未输注含糖液体。按入院时CT检查结果分硬膜外血肿(n=98)、急性硬膜下血肿(n=67)、脑内血肿(n=119)。依据格拉斯哥昏迷量表计分将患者病情严重程度分为3组:三四分组(n=78)、五六分组(n=85)、七八分组(n=121)。全部患者进行外科手术治疗,硬膜外放置颅内压监护装置进行颅内压监测。入院时和术后测定血糖。依据治疗结果(6个月后的格拉斯哥结局量表计分)将患者分为两组:效果良好组(≥4分)、效果差组(≤3分)。结合临床病情、颅内压及治疗效果进行对比研究。结果:284例患者全部进入结果分析。①根据格拉斯哥昏迷量表计分分组,在入院时和术后三四分组的血糖水平高于七八分组[(12.0±0.8),(11.4±0.5),(10.2±0.6),(9.7±0.8)mmol/L,P<0.05]。在每组中入院时与术后的血糖水平相比没有显著差别(P>0.05)。②根据CT检查分组发现,硬膜外血肿组、急性硬膜下血肿组、脑内血肿组血糖水平在入院时和术后均没有明显差别(P>0.05)。③根据治疗结果分组,入院时和术后的血糖水平比较,效果差组明显高于效果良好组[(11.8±0.5),(9.8±0.5),(11.5±0.4),(8.1±0.3)mmol/L,P<0.01]。④颅内压与入院时血糖水平没有明显的相关,然而在术后24h内最大颅内压值和术后血糖水平相关(r=0.383,P<0.01),术后血糖值越高,其颅内压也越高。结论:血糖水平与脑损伤的严重程度、颅内压及治疗效果密切相关,高血糖越高病情越严重。术后血糖越高,颅内压越高,治疗效果越差,预后不良。血糖水平是判断严重颅脑损伤预后的重要指标之一。     

Intracranial pressure monitoring and case mix-adjusted mortality in intracranial hemorrhage

OBJECTIVE: Intracranial pressure (ICP) monitoring is frequently used in intensive care treatment of patients with intracranial hemorrhage. Data demonstrating an improved outcome from this intervention are lacking. We analyzed standardized mortality ratios in patients with and without ICP monitoring to determine its efficacy. DESIGN: A nonrandomized study of case records of consecutively admitted intensive care unit (ICU) patients with intracranial hemorrhage. SETTING: General and medical ICU of a 900-bed tertiary-care hospital. PATIENTS: A total of 225 patients with intracranial hemorrhage (mainly nontraumatic) admitted consecutively between April 1997 and March 2000. MEASUREMENTS: Simplified Acute Physiology Score (SAPS) II, diagnosis, age, sex, use of ICP monitoring, and in-hospital mortality rates were collected from the hospital's ICU database. Expected mortality was provided by means of SAPS II. Standardized mortality ratios were calculated and compared in 119 patients with ICP monitoring and 106 patients without ICP monitoring. MAIN RESULTS: The case mix-adjusted hospital mortality in the group with ICP monitoring was in the expected range (standardized mortality ratio, 1.09 [95% confidence interval (CI), 0.87-1.31]). Patients without ICP monitoring had a significantly higher standardized mortality ratio than expected (1.26 [95% CI, 1.06-1.46]). CONCLUSIONS: A beneficial effect of ICP monitoring in patients with intracranial hemorrhage may be reflected in an improved standardized mortality ratio.