颅内压及灌注压监测在弥漫性轴索损伤中的应用

目的探讨连续动态颅内压及灌注压监测在弥漫性轴索损伤救治过程中的应用价值。方法收集2012年1月—2016年4月福建医科大学附属宁德市医院神经外科及ICU病房收治的弥漫性轴索损伤(GCS 3~8分)患者45例,采用随机数字表法分为监测组和对照组,监测组22例行颅内压监测并依据监测结果控制颅内压,对照组23例未行颅内压监测。观察比较两组患者的预后、住院期间甘露醇用量及发生迟发性颅内出血和继发性脑梗死的发生率。结果监测组死亡及植物生存者发生率为9.10%,低于对照组(39.13%),差异有统计学意义(P0.05),监测组预后较好;住院期间监测组的甘露醇用量平均628.64g,低于对照组的1 208.70g,差异有统计学意义(P0.05);两组迟发性颅内出血和脑梗死的发生率差异无统计学意义(P0.05)。结论持续颅内压及灌注压监测在弥漫性轴索损伤救治中能及时发现颅内压及灌注压的变化,指导治疗并改善患者的预后。

Evaluation of intracranial pressure monitoring and cerebral perfusion pressure in the treatment of diffuse axonal injury

Objective To investigate the clinical value of the continuous dynamic monitoring of intracranial pressure and cerebral perfusion pressure in the treatment of diffuse axonal injury .Methods Totally 45 cases ( GCS 3-5) of diffuse axonal injury hospitalized in our department and intensive care unit from Jan .2012 to Apr.2016 were collected and randomly divided into the monitoring group and control group .Twenty-two patients in the monito-ring group received intracranial pressure monitoring ,and the intracranial pressure was controlled based on the moni-toring results,and 23 patients in the control group had no intracranial pressure monitoring .The prognosis,dose of mannitol and the incidence rate of delayed intracranial hematoma and cerebral infarction were compared between the two groups.Results The incidence of death and plant survival in the monitoring group was 9.10%,less than those of the control group ( 39.13%) with statistical significance ( P<0.05 ) , and the prognosis in the monitoring group was better than that in the control group .The dose of mannitol in the monitoring group (628.64g) was less than that of the control group(1208.70g) with significant difference(P<0.05).About delayed intracranial hematoma and cerebral infarction,there was no significant difference between the two groups (P>0.05).Conclusion Continuous dynamic monitoring of intracranial pressure and cerebral perfusion pressure can detect the changes of pressure timely in the treatment of diffuse axonal injury ,and then the appropriate treatment measures could be taken to improve the outcomes of patients .