有创颅内压监测在重型颅脑损伤救治中的应用(1)
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【摘要】 目的 探讨有创颅内压监测在重型颅脑损伤救治中的临床意义。 方法 将126例重型颅脑损伤损伤患者随机分成2组进行前瞻性研究，每组63例。监测组患者入院后24 h内或开颅术后行侧脑室穿刺，放置颅内压(ICP)监测装置，根据ICP结果采取相应的治疗措施，将治疗结果与非监测组进行比较研究。 结果 按GOS标准评定，治疗后3个月评定治疗结果。监测组13例死亡，6例植物生存，3例重残，7例轻残，34例良好，与对照组比较治疗效果有显著差异( P <0.05)。监测组与对照组预后良好率分别为65.1%和46.0%( P <0.05)。 结论 重型颅脑损伤患者救治过程中行有创颅内监测，能动态地观察颅内压力变化情况，为临床上及时处理颅内高压提供客观准确的依据，为改善预后起到了积极的救治作用。
【关键词】
重型颅脑损伤；颅内压
Application of invasive intracranial pressure monitoring in treatment of severe traumatic brain Injury
SU Guo-jun， HAN Rui-zhang， YU Fen，et al.
Department of Neurosurgery， CPLA No. 98 Hospital，Huzhou Zhejiang 313000,China
【Abstract】 Objective
To investigate the clinical significance of invasive intracranial pressure(ICP) monitoring in treatment of severe traumatic brain injury(sTBI). Methods A total of 126 patients of sTBI were randomly divided into two groups and analyzed by prospectively,63 cases in each group. The monitoring group were embed of invasive ICP monitoring device within firest 24 hours or after surgery, treated according to the ICP, and comparied its results with control group. Results The outcome were evaluated by Glasgow outcome scale (GOS) after 3 months,there were 34 patients with good recovery, 7 with moderate disability, 3 with severe disability, 6 in vegetative status and 13 patients who had died.Treatment effects had significant difference ( P <0.05). The favorable prognosis rate of monitoring group and control group was 65.1% and 46.0% ( P <0.05). Conclusion During the treatment of sTBI patients,the invasive intracranial pressure monitoring can dynamicly observe ICP, provide the objective and accurate evidence, and improve the prognosis.
【Key words】
Severe traumatic brain injury(sTBI); Intracranial pressure(ICP)
重型颅脑损伤是颅脑损伤中的常见病，多发病，常引起颅内压(ICP)增高和脑灌注压(CPP)降低，其病死率极高，是严重威胁人类健康的疾病之一，颅内压的监测对了解病情的变化，指导临床上救治具有重要意义。颅内压的监测可分为有创和无创两大类，无创颅内压监测尚处于研究和临床试用阶段，其准确性和稳定性仍无法判断，所以不推荐临床应用，目前临床上广泛应用的均为有创颅内压监测范畴[1]。综合文献报道，目前国内外对颅内压监测的大规模随机对照研究(Ⅰ级证据)较少[2,3]，我科2007年3月至2011年7月采用有创颅内压监测法对126例重型颅脑损伤患者进行前瞻性研究 ......
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