有创颅内压监测在重型颅脑损伤手术中的应用研究

doi:10.16260/j.cnki.1009-2188.2018.01.012

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摘要目的?探讨持续动态颅内压监测在重型颅脑损伤中的临床应用价值。方法?回顾性分析2015年1月至2017年1月在湖南中医药大学第一附属医院院神经外科接受治疗的68例重型颅脑损伤患者的临床资料，其中34例采用持续动态颅内压监测 (研究组)，另34例采用间隔腰椎穿刺颅内压监测 (对照组)。结果?研究组根据监测行开颅手术15例，对照组手术13例。两组手术患者术后1h、6h、12h、24h ICP较术前均有明显下降，组内手术前后比较具有显著统计学差异(P<0.01)；研究组术后各时间点ICP较对照组均有明显下降，组间比较具有显著统计学差异(P<0.05)。两组患者术后24h、72h和3d GCS评分较术前均有明显下降，组内手术前后比较具有显著统计学差异(P<0.01)；研究组术后72h和3d GCS评分较对照组均有明显下降，组间比较具有显著统计学差异(P<0.01)。研究组格拉斯哥预后分级死亡2例，GOSⅡ级4例，Ⅲ级6例，Ⅳ级15例，Ⅴ级7例；对照组死亡3例，GOSⅡ级7例，Ⅲ级15例，Ⅳ级6例，Ⅴ级3例，两组比较有统计学差异(P<0.05)。研究组出现1例颅内感染的患者，对照组出现2例颅内感染的患者，两组间比较无统计学差异(χ2=0.349，P=0.555)。结论?对重型颅脑损伤患者行持续动态有创颅内压监测，在病情判断及手术时机选择方面疗效较为显著，值得临床推广应用。

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	余文运，罗刚，喻坚柏

关键词: 有创颅内压监测持续动态监测重型颅脑损伤

Abstract: Objective?To explore the clinical effects of continuousdynamic invasive monitoring of intracranial pressure (ICP) in severe craniocerebral injury patients.Methods?Retrospective analysis was carried out in 68 severe craniocerebral injury patients treated in Department of Neurosurgery of the First Affiliated Hospital of Hunan University of Chinese Medicine from January,2015 to January,2017.There were 34 cases whose ICP wasdetected by continuousdynamic invasive pressure monitoring in group A,and another 34 patientsdetected by lumbar puncture in group B.Results?There were 15 and 13 patients underwent craniotomy procedures according to the ICP results respectively in group A and B.In the operated patients,the ICP of group A was significantly lower than that of group B at 1h，6h，12h and 24h after operation (P<0.05).And the postoperative 72h and 7d GCS of group A was significantly lower than that of group B (P<0.01).According to the Glasgow outcome scale(GOS),there were 2 cases of gradeⅠ,4 cases of GOS Ⅱ,6 cases of grade Ⅲ,15 of gradeⅣ and 7 of grade Ⅴ in group A.And in group B,the number was 3,7,15,6 and 3 respectively (P<0.05).There were 1and 2 cases got intracranial infection in group A and B respectively (χ2=0.349,P=0.555).Conclusion?Ithas a significant clinical effect of continuousdynamic invasive intracranial pressure monitoring in the treatment of severe traumatic brain injury,which is worthy of clinical application.

Key words: invasive intracranial pressure monitoring continuousdynamic monitoring severe craniocerebral injury

发布日期: 2018-08-13 期的出版日期: 2018-08-13

ZTFLH:

R651.15

基金资助: 长沙市科技局2016年度第一批指导性科技计划项目(编号：ZD1601092)

通讯作者: 余文运

作者简介: 余文运，男，38岁，湖南中医药大学第一附属医院神经外科主治医师。

引用本文:

余文运，罗刚，喻坚柏. 有创颅内压监测在重型颅脑损伤手术中的应用研究[J]. 中国现代手术学杂志, 2018, 22(1): 45-48.
YU Wen-yun. The Clinical Application of Continuous Dynamic Invasive Intracranial Pressure Monitoring in SevereCraniocerebral Injury. Chinese Journal of Modern Operative Surgery, 2018, 22(1): 45-48.

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http://www.surgerychina.com/CN/10.16260/j.cnki.1009-2188.2018.01.012 或 http://www.surgerychina.com/CN/Y2018/V22/I1/45

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