严重脑外伤急性期颅内压与血儿茶酚胺变化的关系及其意义

报告５１例严重脑外伤急性期持续ＩＣＰ监护和血ＣＡ测定结果，发现脑外伤组血ＣＡ明显高于对照组（Ｐ＜０．００１）。脑外伤后２４小时内ＩＣＰ与血ＮＥ、Ｅ水平显著呈正相关（ｒ＝０．７３０，Ｐ＜０．００１和ｒ＝０．５４２，Ｐ＜０．００１），脑外伤后第三天ＩＣＰ与血ＮＥ、Ｅ亦显著呈正相关（ｒ＝０．６０４，Ｐ＜０．００１和ｒ＝０．４５１，Ｐ＜０．０１）。伤后２４小时ＩＣＰ正常或轻度增高者，６５％恢复良好．３５％恢复差，而ＩＣＰ＞５．３ｋＰａ组病人，９０％以上死亡。伤后第三天ＩＣＰ仍高于５．３ｋＰａ的４例病人全部死亡。     

Axonal damage in severe traumatic brain injury: an experimental study in cat

Summary Based upon recent clinical findings, evidence exists that severe traumatic brain injury causes widespread axonal damage. In the clinical setting, it has been assumed that such axonal damage is the immediate consequence of traumatically induced tearing. However, in laboratory studies of minor head injury, evidence for primary traumatically induced axonal tearing has not been found. Rather the traumatic event has been linked to the onset of subtle axonal abnormalities, which become progressively severe over time (i.e., 12–24 h). In the light of these discrepant findings, we investigated, in the present study, whether progressive axonal change other than immediate tearing occurs with severe traumatic brain injury. Anesthetized cats were subjected to high intensity fluid-percussion brain injury. Prior to injury all animals received cortical implants of horseradish peroxidase (HRP) conjugated to what germ agglutinin to anterogradely label the major motor efferent pathways. Such an approach provided a sensitive probe for detecting traumatically induced axonal abnormality via both light microscopy (LM) and transmission electron microscopy (TEM). The animals were followed over a 1- to 6-h posttraumatic course, and processed for the LM and TEM visualization of HRP. Through such an approach no evidence of frank traumatically induced tearing was found. Rather, with LM, an initial intra-axonal peroxidase pooling was observed. With time, unilobular HRP-containing pools increased in size and progressed to bi- or multilobulated profiles. Ultimately, these lobulated configurations separated. Ultrastructurally, the initial unilobular pool was associated with organelle accumulation and focal axolemmal distention without frank disruption. Over time, such organelle accumulations increased in size and sequestered into multiple pools reminiscent of the bi- and multilobulated structures seen with LM. Ultimately, these organelle accumulations became detached, resulting in physically separated proximal and distal organelle-laden swellings surrounded by a distended axolemma and thinned myelin sheath. The findings reject the hypothesis that axons are immediately torn upon impact.Supported by NIH grants NS-20193, NS-12587 and NS-07288     

颅脑创伤患者颅内压相关参数与预后关系的研究

目的 探讨颅脑创伤患者的颅内压（ICP）相关参数与预后的关系.方法 回顾性纳入2016年11月至2017年10月上海交通大学医学院附属仁济医院神经外科重症监护室收治的50例闭合性颅脑创伤患者.患者均行有创颅内压、动脉压监测,采用Neumatic DCR数据采集系统监测ICP相关参数.根据出院时格拉斯哥预后分级（GOS）将患者分为预后不良组（GOS Ⅰ、Ⅱ级）20例和预后相对良好组（GOSⅢ-Ⅴ级）30例.比较两组患者的ICP相关参数,采用受试者工作特征曲线（ROC）评估相关参数的预测能力.结果 （1）与预后相对良好组比较,预后不良组的ICP[（26.2±13.4）mmHg对比（14.0±5.6） mmHg]、压力反应指数（PRx,0.48±0.21对比0.12 ±0.08）及ICP波幅与动脉压波幅的相关系数（IAAC,中位数为0.14对比0.01）均升高,平均脑灌注压[CPP,（48.9±19.9） mmHg对比（81.1±6.9）mmHg]降低,差异均有统计学意义（均P〈0.01）;ICP波幅与ICP的相关系数（RAP）差异无统计学意义（P〉0.05）.多因素二元Logistic回归分析显示,ICP（OR=2.187,95％ CI：1.079-4.431,P=0.031）、PRx（OR=21.608,95％ CI：3.012-155.014,P=0.002）是预后的独立影响因素.（2）预后不良组在20 mmHg及22 mmHg阈值上的ICP“剂量”（DICP20、DICP22）均高于预后相对良好组（均P〈0.05）.DICP20的ROC曲线下面积为0.70,DICP22为0.71.预后不良组在0.25及0.05阈值上的PRx“剂量”（D PRx0.25、DPRx0.05）均高于预后相对良好组;DPRx0.25的曲线下面积为0.97,DPRx0.05为0.96.结论 ICP和PRx为颅脑创伤患者不良预后的独立危险因素;ICP“剂量”和PRx“剂量”均可作为判断患者死亡及植物状态预后的参数,且PRx“剂量”的准确性更高.     

脑组织氧分压脑灌注压及颅内压对重型颅脑创伤患者预后的影响

目的探讨脑组织氧分压、脑灌注压及颅内压对重型颅脑创伤患者预后的影响。方法观察112例重型颅脑损伤病人脑灌注压（CCP）、颅内压（ICP）、脑组织氧分压（PbtO2）的变化,比较CCP、ICP、PbtO2与预后的相互关系。结果 PbtO2（24h及72h）与预后有显著性相关,随着PbtO2的升高,预后良好的比例明显升高。ICP（24h及72h）与预后显著相关,随着ICP的升高,预后良好的比例明显下降。CCP（24h及72h）与预后有显著性相关,随着CCP的升高,预后良好的比例明显升高。结论 PbtO2、ICP、CPP与预后均有显著相关性,24h及72h的CCP、ICP对预后有显著影响。     

重型颅脑损伤患者甘露醇、速尿和白蛋白降颅压作用的临床观察

目的观察甘露醇、速尿和白蛋白在不同使用方法和剂量上的降颅压效果,探讨临床合理的药物降颅压方法。方法124例重型颅脑损伤患者随机分为5组,全部进行持续颅内压(ICP)监测,连续观察静脉使用甘露醇、速尿和白蛋白后的ICP、血钾、血钠和血尿素氮(BUN)的变化。结果甘露醇和速尿降ICP作用明显(P<0.05);半量甘露醇加速尿或白蛋白降ICP作用显著(P<0.05)且持续时间长(P<0.05);降ICP的过程中可能出现电解质、肾功能的异常和ICP的反跳现象。结论半量甘露醇+速尿降ICP的方法值得临床提倡;半量甘露醇联合使用中、大剂量白蛋白在有条件的情况下也是适宜的降ICP方法。     

大骨瓣减压术治疗颅脑创伤后顽固性高颅压

目的 探讨大骨瓣开颅减压术(DC)治疗重型颅脑创伤(sTBI)后顽固性高颅压的作用及实施DC的时机对预后的影响.方法 回顾性分析132例临床资料,根据伤后6个月时的GOS评分将其分为良好组(GOS 4～5分,n=55),不良组(GOS 2～3分,n=46)和死亡组(GOS 1分,n=31).研究DC对于sTBI患者伤后颅内压(ICP)和脑灌注压(CPP)治疗作用及不同时间实施DC对预后的影响.结果 本研究病例的死亡率为23.5%(31/132),恢复良好率41.7%(55/132).DC前后的ICP平均值为(35.0±12.8)mmHg和(18.3±12.0)mmHg(P＜0.05)、CPP平均值为(50.2±12.4)mmHg和(60.6±12.0)mmHg(P＜0.05),在恢复良好组,DC前后这两个指标变化则更为显著.在伤后不同时间段实施DC与死亡率和恢复良好率无显著相关性.结论 DC对于sTBI后弥漫性脑肿胀、脑水肿所致顽固性高颅压患者在存活组比死亡组更能有效地降低ICP和升高CPP,而伤后实施DC的时间对于预后影响不明显.DC后持续存在ICP≥25 mmHg是预测死亡的敏感指标.

Abstract：

Objective To investigate the role of decompressive craniectomy (DC) to decrease the intractable intracranial hypertension(ICH) due to the diffuse brain swelling and/or cerebral edema after severe traumatic brain injury and the time window of DC to affect on the prognosis.Methods The clinical record of 132 patients who underwent DC for post- traumatic intractable ICH in our hospital from July 2003 to December 2009 with sTBI(Glasgow coma scale≤8) were analyzed retrospectively.The outcome was as measured by Glasgow Outcome Scale (GOS) at the 6th month post-trauma and these patients were divided into favorable group(GOS 4～5,n = 55 ),unfavorable group (GOS 2 ～ 3,n = 46) and Death (GOS 1,n = 31 ).The influence of DC on intracranial pressure (ICP),cerebral perfusion pressure (CPP) and timing of DC on prognosis were analyzed.Methods Of 132 patients,mortality was 23.5% (31/132 ),favorable outcome was observed in 41.7% (55/132 ).Through undergoing DC,ICP decreased from (35.0±12.8) mmHgto (18.3±12.0) mmHg(P＜0.05)and CPP increased from (50.2±12.4)mmHg to (60.6±12.0)mmHg(P＜0.05).These changes were more significant in survivors than in non- survivors (P=0.001 and P=0.003).No tendency towards either increased or decreased in favorable outcome and mortality was found relative to the timing of DC post-trauma.Persistent ICP≥25 mmHg of post- DC was a predicted parameter of mortality(sensitivity 81.6% ,specificity 92.4%,positive predictive value 68.4%,negative predictive value 94.7%).Conclusion DC deceased ICP and increased CPP more obviously in survivors compared to non-survivors in sTBI with ICH.The timing of DC showed no clear trend,for either good neurological outcome or death.The postoperative ICP ≥ 25 mmHg was a threshold to predicted mortality.     

颅内压监测对重型创伤性颅脑损伤患者临床疗效的Meta分析

目的系统评价持续颅内压(ICP)监测对重型颅脑损伤(TBI)患者疗效与安全性的影响。方法计算机检索Cochrane Library、MEDLINE、EMbase、CNKI、万方等数据库,收集符合纳入标准的研究,检索时限均为从建库至2015年3月,并追溯纳入研究的参考文献和手工检索相关会议资料。由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用Rev Man5.2软件进行Meta分析。结果共纳入1个随机对照研究,11个病例对照研究。Meta分析结果显示,与传统的临床和影像学监测对照组相比,ICP监测组的病死率并未显著降低,OR=0.87,95%CI(0.62,1.22),P=0.42。亚组分析结果显示,在经济发达及欠发达地区,ICP监测组与对照组的病死率相比,差异无统计学意义。2012年以后发表的文献合并OR值显示,ICP监测可显著降低病死率,OR=0.61,95%CI(0.39,0.95),P=0.03;ICP监测组与对照组ICU病死率及6个月的病死率相比,差异均无统计学意义;仅2周的病死率显著减少,OR=0.52,95%CI(0.40,0.68),P0.01。结论对于重型TBI患者,持续ICP监测的临床疗效受多方面因素的影响,统一研究对象的纳入标准及ICP的规范化应用将会得出更为可靠的临床结论。     

脑水肿与颅内压的监测和临床观察

脑水肿、颅内压(intracranial pressure,ICP)增高的诊断主要依靠临床观察、影像学检查和ICP监测三者结合.传统的CT和核磁共振虽然可以作为颅内血肿、脑水肿和ICP增高的检测方法,但它们不能对颅内血肿和脑水肿进行实时动态的监测,也不能反映脑水肿、颅内血肿的演变过程,给临床及时治疗带来难度.     

Transcranial Doppler monitoring in severe brain damage: relationships between intracranial haemodynamics, brain dysfunction and outcome

Transcranial Doppler (TCD) monitoring in the middle cerebral (MCA) and common carotid arteries (CCA) was studied in 105 comatose patients with severe brain damage. TCD-measured velocity waveforms in the MCA were evaluated in relation to loss of cerebral function as assessed by EEG and compressed spectral arrays, loss of brain stem function as measured by somatosensory and auditory evoked potentials, loss of all brain function and the clinical outcome. The velocity waveforms exhibited six patterns: continuous forward flow (FF); diastolic no flow (NF); diastolic reverse flow with (RF) or without (DRF) diastolic FF; brief systolic FF (SFF); and undetectable (U). In the 58 fatal cases, the appearance of RF/DRF or SFF in the MCA more often preceded loss of brain stem function than loss of cerebral function. A U pattern in the MCA, which was confirmed by loss of FF in the CCA, was correlated with loss of brain stem function. Only one of the 47 survivors showed DRF in the MCA. No patients in whom SFF or U was observed in the MCA survived. Therefore the presence of these patterns is reliably predictive of brain death. Intracranial diastolic reverse flow (DRF), however, indicates imminent loss of brain function and the need for prompt resuscitative measures.     

川芎嗪对脑外伤患者血栓素、前列腺环素及颅内压的影响

28例重度脑外伤患者分为川药嗪治疗组和一般治疗对照组,两组病人均于用药前和用药后3小时测定血浆和脑室内脑脊液(VCSF)中血栓素代谢产物(TXB_2)前列腺环素代谢产物6—酮—PGF_(la)(6KP)和颅内压。结果表明:两组治疗前血浆、VCSF中TXB_2及T/K均明显高于正常献血员对照组,川芎嗪能降低脑外伤患者血浆、VCSF中TXB_2及T/K值,对颅内压则无明显影响。提示川芎嗪能抑制脑外伤对血小板的激活、纠正循环血中TXA_2—PGI_2平衡失调,从而改善脑微循环。     

Traumatically induced axonal damage without concomitant change in focally related neuronal somata and dendrites

Summary Traumatic head injury has long been associated with the genesis of reactive axonal change, which many believe to be a major factor in influencing neurological outcome. Although much significance has been attached to such a traumatically induced axonal change, little information exists as to whether such a reactive change occurs as an isolated event or rather as an event associated with concomitant focal tissue damage, possibly involving related neuronal somal and dendritic elements. This issue was critically assessed in mechanically brain-injured cats in which the anterograde axonal transport of horseradish peroxidase was employed to detect reactive axonal change. Following such traumatically induced reactive axonal change over a 21-day post-traumatic period, altered axons were consistently observed within the red, vestibular and reticular nuclei and any evidence for concomitant change within the related neuronal somal and dendritic elements was assessed using light and electron microscopy. Typically, such axonal change occurred without any evidence of focally related somatic or dendritic alteration. Isolated examples of reactive axons approximating neurons undergoing chromatolysis were observed. However, such neuronal chromatolytic change appeared not to be a primary response to trauma, but rather a response secondary to severence of these neurons' axonal projections. The results of this study demonstrate that, in mild to moderate head injury, reactive axonal change does occur in isolation from other forms of focal parenchymal abnormality. This finding, therefore, emphasizes the concept that the number of axons damaged is most likely related to the magnitude of any ensuing neurological abnormality.Supported by NIH grants NS 12587 and NS 20193 designated as a Javits Neuroscience Investigator Award     

2058例重型颅脑创伤颅内压动态监护分析

目的 探讨颅内压(intraeranial pressure,ICP)持续动态监护对重型颅脑创伤(severe traumatic brain injury,sTBI)救治的指导意义.方法 分别采用脑窜内及脑实质内ICP监护法,对2058例sTBI患者进行ICP持续动态监护,观察ICP与患者生命体征、临床表现和预后的关系,分析其对脑室外引流及其他降颅压治疗的指导作用.结果 ICP持续动态监护末并发严重颅内感染及出血,脑室外引流对持续ICP增高者有显著的治疗作用,ICP值与患者预后呈显著负相关.结论 ICP持续动态临护安全、易行,其有助于sTBI患者病情变化的及时、正确判断,能为临床医生制定治疗方案及预后病人评估提供重要的参考依据.     

双侧平衡去骨瓣减压术对特重型颅脑伤致双瞳散大患者的救治

目的 探讨双侧平衡去骨瓣减压术在治疗特重型颅脑外伤致双瞳散大患者中的作用.方法 对我科2005年1月至2010年12月收治的58例单侧损伤灶所致特重型颅脑外伤致双瞳散大手术患者进行回顾性分析,其中2005年1月至2007年9月仅行病灶侧去骨瓣减压术30例(A组),2007年10月至2010年12月采用双侧平衡去骨瓣减压术28例(B组),分析并比较两组患者颅内压、预后及并发症情况.结果 采用双侧平衡去骨瓣减压术者较仅对血肿侧去骨瓣减压者颅内压下降差异有统计学意义;死亡率下降了25.2%,预后良好率上升了26.9%.结论 双侧平衡去骨瓣减压术可有效降低特重型颅脑外伤致双瞳散大患者的颅内压,减少急性脑膨出和脑梗死的发生率,降低死亡率.

Abstract：

Objective To explore the effect of bilateral balanced decompressive craniectomy in treatment of the most severe brain injured patients with bilateral mydriasis. Methods Fifty - eight cases of the most severe brain injury due to unilateral lesions with bilateral mydriasis were analyzed retrospectively from Jan 2005 to Dec 2010. Thirty were treated by unilateral decompressive craniectomy from Jan 2005 to Sep 2007(group A) and 28 by bilateral balanced decompressive craniectomy from Oct 2007 to Dec 2010(group B). The intracranial pressure, prognosis and complications were compared. Results Postoperative ICP was significantly lower in group B than group A; patients in group B had a lower mortality and better outcome than in group A. Conclusion Bilateral balanced decompressive craniectomy can efficiently reduce the values of ICP, occurrence of acute encephalocele and brain infarction and mortality of the most severe brain injured patients with bilateral mydriasis.     

Serum ceruloplasmin and copper are early biomarkers for traumatic brain injury‐associated elevated intracranial pressure

High intracranial pressure (ICP) is a prominent secondary pathology after traumatic brain injury (TBI) and is a major contributor to morbidity and mortality. Currently, there are no clinically proven methods for predicting which TBI patients will develop high ICP. In the present study, we examined whether the serum levels of the copper‐binding protein ceruloplasmin are differentially altered in patients with elevated ICP (≥25 mmHg) vs. those whose ICP remained below 20 mmHg throughout the study period. Consistent with its role as an acute‐phase reactant, we found that ceruloplasmin levels were significantly increased by 3 days post‐TBI compared with healthy volunteers. However, prior to this delayed increase, ceruloplasmin levels during the first 24 hr following injury were found to be significantly reduced in patients who subsequently developed high ICP. This decrease was found to have prognostic accuracy in delineating TBI patients based on their ICP status (cutoff of 140 μg/ml; sensitivity: 87%, specificity: 73%), Likewise, low total serum copper (below 1.32 μg/ml) was also found to be predictive of high ICP (sensitivity 86%, specificity 73%). These results suggest that initial serum ceruloplasmin/copper levels may have diagnostic value in predicting patients at risk for developing high intracranial pressure. © 2010 Wiley‐Liss, Inc.     

中重度颅脑损伤后CT影像特点、颅内压与预后的关系

目的研究中、重度颅脑损伤病人颅内压、CT影像特点及预后之间的关系.方法对28例中、重度颅脑损伤病人行颅内压监测和头部CT扫描,记录颅内压值和CT影像特点(基底池受压、中线移位、脑室受压情况),并进行Rotterdam CT评分,对这些因素进行统计学分析.结果经统计学分析:各CT影像特点与颅内压水平存在相关性,Rotterdam CT评分与颅内压水平的相关性最强.伤后24 h颅内压水平与病人预后相关性最强,而中线移位和脑室受压情况与预后无明显相关性.结论在评估中、重度颅脑损伤病人颅内压及预后方面,Rotterdam CT评分优于单个CT影像特征;颅内压与病人预后存在负相关,对中重、度颅脑损伤行颅内压监测,并进行相关治疗有利于改善预后.     

高容量血液滤过对重型颅脑损伤患者颅内压的影响

目的观察重型颅脑损伤患者应用高容量血液滤过(HVHF)对其颅内压(ICP)及预后的影响。方法选取90例GCS评分3~8分的颅脑损伤患者按照治疗方法不同分为治疗组60例与对照组30例,对照组给予常规治疗措施,治疗组在此基础上给予HVHF,连续治疗2周后评价患者ICP变化及预后。结果治疗组3 d、7 d及14 d时颅内压均明显低于对照组(P0.05),3 d、7 d及14 d时血清IL-6、TNF-α值均明显低于同期对照组(P0.05),术后并发症及死亡率均明显低于对照组(P0.05),具有统计学意义。结论重型颅脑损伤患者术后应用HVHF治疗可显著降低颅内压增高曲线,改善患者预后。     

中、重型颅脑损伤患者脑血流动力学变化与颅内压、脑灌注压的相关性研究

目的 探讨经颅多普勒（TCD）无创检测中、重型颅脑损伤患者的脑血流动力学变化与颅内压和脑灌注压的关系。方法 前瞻性研究52例急性中、重型颅脑损伤患者的双侧大脑中动脉血流动力学状态，TCD检测脑血流动力学参数包括收缩期血流速度（Vp）、舒张期血流速度（Vd）、平均血流速度（Vm）、搏动指数（PI）、阻力指数（RI），持续监测颅内压（ICP）和脑灌注压（CPP）、平均动脉血压（MABP）。对脑血流动力学参数、MABP与ICP、CPP进行相关性分析。结果 PI、RI与ICP正相关系数分别为PI：r=0．881（P＜0．0001）；RI：r=0．789（P＜0．0001），ICP和CPP与PI、RI、Vd、Vm、MABP多元逐步回归分析发现PI与ICP，CPP与PI、MABP关系最为密切（P＜0．0001）。结论 无创脑血流动力学检测可实时反映ICP和CPP的变化，可作为ICP和CPP监测的一种有效方法，具有无创、安全、价廉的特点，易于临床推广应用。     

Hypertonic saline solution for control of elevated intracranial pressure in patients with exhausted response to mannitol and barbiturates

Abstract

Critically elevated intracranial pressure (ICP) represents the most important cause of morbidity and mortality in patients suffering from severe traumatic brain injury (TBI) and is a serious complication after subarachnoid hemorrhage (SAH). Thus new strategies for the control of ICP are required. Based on the evidence available hypertonic saline solution (HSS) may be a promising approach. It was therefore the aim of the present study to evaluate in a prospective manner the effects of HSS on ICP and cerebral perfusion pressure (CPP) in patients with therapy-resistant elevation of ICP. A total of 48 bolus infusions of HSS (7.5%, 2 ml kg'1 b.w.; infusion rate 20 ml min*1) were given intravenously (range 1-15 per patient) to 10 patients (age 41 ±6 years) with TBI and SAH. Only patients with ICP > 25 mmHg not responding to standard ICP- management protocol and plasma sodium (Na+) concentration < 150 mmol I-1 were included in the study. Within the first hour after HSS application, ICP decreased from 33±9 mmHg to 19 ±6 mmHg (p < 0.05) and further to 18±5 mmHg at the time of maximum effect (98 ±11 min post bolus). Decrease of ICP was accompanied by a rise of CPP from 68±11 mmHg to 79±11 mmHg fp < 0.05) after 1 h and further to 81 ± 7 7 mmHg at the time of maximum effect. Plasma Na+ concentration was 141 ±6 mmol l~1 before and 143 ±5 mmol I-1 1 h after HSS bolus. Corresponding values for plasma osmolality were 302 ± 11 and 308 ± 12 mOsm t~1. When the ICP lowering effect was transient, subsequent HSS bolus was necessary 163 ±54 min after previous dosing. The present results indicate that repeated bolus application of HSS (7.5% NaCI, 2 ml kg~ b.w.) is an effective measure to decrease ICP which is otherwise refractory to standard therapeutic approaches. Whether or not the therapy scheme is also suited as primary measure for the control of ICP remains to be established. [Neurol Res 1999; 21: 758-764]     

重型颅脑损伤中脑温脑组织氧分压持续监测

目的研究重型颅脑损伤中脑温(BT)、脑组织氧分压(PbtO2)的持续变化及其意义.方法应用脑温、脑组织氧分压(PbtO2)探针脑白质温度、脑组织内物理性溶解的氧的压力.结果通过对10例重型闭合性颅脑损伤患者研究分析发现(1)在诱导低温后,直肠温度(RT)与BT的差异比正常体温时明显.(2)在重型颅脑伤后,PbtO2值降低,PbtO2＜10mmHg时,可认为是脑缺氧的阈值.(3)伤后24小时内PbtO2＜5mmHg预示病人预后不良.(4)脑组织氧分压测定技术可指导过度换气的应用.结论在低温状态下,RT与BT的差异加大,因此,在研究低温对脑外伤的影响时,最好能直接测量脑温.脑组织氧分压监测安全可靠,是脑组织氧合程度的一种灵敏的监测方法,它可以提示预后,并且对临床治疗具有重要的指导作用.     

术中颅内压监测在治疗重型颅脑创伤中的应用

目的 探讨术中持续颅内压(ICP)监测在治疗重型颅脑创伤患者中的应用价值.方法 对我科2008年3月至2010年3月收治的58例重型颅脑创伤患者的术中ICP监测结果进行分析.根据预后情况分为较好组(GOS 4 ～5分)和较差组(GOS1 ～3分),分析并比较两组患者开颅术中ICP的波动规律及其对手术操作和预后的影响.结果 两组间手术初始、去除骨瓣后及关颅术后的ICP均值以及两组各步骤间ICP波动变化差异有统计学意义(P＜0.01).结论 术中ICP监测在治疗重型颅脑外伤患者中有助于及时发现问题,指导治疗及评估预后,具有重要的临床应用价值.