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.