无创颅内压监测在急诊中的应用

目的探讨经多普勒（TCD）监测颅内压在颅脑损伤急诊中的作用,总结多普勒监测在颅脑损伤急诊中临床实际经验。方法对20例重症颅脑损伤患者的治疗资料进行回顾性分析,将其分为治疗组和对照组,各10例。其中对治疗组于急诊过程中使用TCD检测大脑中动脉的收缩峰流速（Vs）,舒张期速度（Vd）,平均血流速度（Vm）,血管搏动指数（PI）,阻力指数（RI）,同时记录颅内压和道格拉斯预后评分（GOS）;对照组中使用传统即刻腰穿测定颅内压的值,同时通过脑管引流,用HorizonXL监护仪进行颅内压的动态监测,然后进行两组分析比较。结果发现随着颅内压的升高,PI,RI,增大,Vd减慢,与对照组相比,其差异显著,具有统计学意义,P〈0.01,且当PI〉1.5时,患者预后不良,P〈0.05。结论经颅多普勒可以无创动态的监测脑外伤患者的颅内压,对重症的颅脑损伤的临床治疗和预后评价有重要意义。

Deng Suzhen-Application of Noninvasive Intracranial Pressure Monitoring in Emergency Treatment

Objective To research into the effects of transcranial Doppler （ TCD） intracranial pressure monitoring in emergency treatment of craniocerebral injury,and to summarize the clinical practical experience of applying Doppler monitoring in emergency treatment of craniocerebral injury. Methods Carried out retrospective analysis on the data of 20 cases of serious craniocerebral injury patients,divided them into a treatment group and a comparison group,with each group made up of 10 cases. For the treatment group,TCD was used in the emergency treatment to check brain arteries peak systolic velocity （ Vs） ,peak systolic velocity （ Vd） ,average flow velocity （ Vm） ,pulse index （ PI） and resistance index （ RI） ,and also recorded intracranial pressure and the Glasgow Outcome Scale （ GOS） ; For the comparison group,traditional mean,i. e. ,lumbar puncture, was used to measure intracranial pressure,and at the same time Horizon XL monitor apparatus was used to carry out dynamic monitoring on intracranial pressure through ventricular drainage,and then compared the two groups. Results It was discovered that as the intracranial pressure rose,PI and RI increased,Vd slowed down,compared with the comparison group,the differences were distinct and had statistical significance,P 0. 01,and when PI 1. 5,the prognosis of patients was poor,P 0. 05. Conclusion Doppler can be used for noninvasive monitoring of intracranial pressure of brain trauma patients. It has importance significance for clinical treatment and prognosis assessment of serious craniocerebral injury cases.