摘要
目的探讨有创颅内压（ICP）监测对治疗创伤性急性双侧半球弥漫性脑肿胀的指导作用以及判断预后的意义。方法2010年2月至2011年10月湖州市解放军第98医院神经外科在有创ICP监测下治疗创伤性急性双侧半球弥漫性脑肿胀59例，前瞻性研究患者入院时ICP、去骨瓣减压患者术前ICP和术后ICP等临床资料，按伤后6个月的GOS评分分为恢复良好组（GOS4～5分）和恢复不良组（GOS1～3分）。探讨入院时ICP、去骨瓣减压患者术前ICP、术后ICP与预后的关系。结果本组病例恢复良好率69％（41／59），恢复不良率31％（18／59），病死率15％（9／59）。入院时GCSi〉9分的患者预后无死亡及植物生存，入院时GCS13～14分的患者均恢复工作或学习（GOS5分）。在持续有创ICP监测下29例施行了去骨瓣减压术。入院时ICP、去骨瓣减压患者术前ICP和术后ICP恢复良好组分别是（22．2±7．9）mmHg、（31．9±9．5）mmHg和（12．3±2．9）mmHg；恢复不良组分别是（33．4±18．9）mmHg、（43．7±14．6）mmHg和（13．0±5．6）rnmHg。两组指标相对应比较，患者入院时ICP、去骨瓣减压患者术前ICP差异有统计学意义（P〈0．05），去骨瓣减压患者术后ICP差异无统计学意义（P〉0．05）。结论持续有创ICP监测对创伤性急性双侧半球弥漫性脑肿胀的治疗有重要的指导作用，此类患者的预后与入院时ICP、去骨瓣减压患者术前ICP有关。
Objective To explore the guiding role of invasive intracranial pressure （ICP） monitoring in the treatment of posttraumatic acute bilateral hemispheric diffuse brain swelling, and to analyze the relationship between ICP and the prognosis. Methods A total of 59 patients with acute posttraumatic bilateral hemisphere diffuse brain swelling, treated under the monitoring of invasive intracranial pressure between Feb. 2010 and Oct. 2011, in our department were chosen for the study. ICP values at admission, before, and after decompressive craniectomy of all 59 patients were collected. The 59 patients were divided into a group of good recovery （COS 4 - 5） and a group of bad recovery （COS 1- 3） based on the Glasgow outcome scale （COS） 6 months after craniocerebral trauma. The relationship between prognosis and ICP at admission, ICP before and after deconrpressive craniectomy was analyzed. Results The good recovery rate was 69% （41/59） and the bad recovery rate was 31% （18/59）, while the death rate was 15% （9/59）. No mortality or plant survival occurred in patients whose GCS i〉 9 at admission, and all patients, whose GCS were between 13 - 14, came back to work or study （COS =5）. Twenty-nine patients accepted decompressive craniectomy under continuous invasive ICP monitoring; for those with good recoveries, ICP at admission, ICP before and after decompressive craniectomy were respectively （ 22. 2 ± 7. 9） mm Hg, （ 31.9 ±9.5） mm Hg, and （12.3 ±2.9） mm Hg; for those with bad recoveries, these indexes were respectively （33.4 ± 18. 9） mm Hg, （43. 7 ± 14. 6） mm Hg, and （ 13. 0 ± 5. 6） mm Hg, There were significant statistic differences between the two groups for the indexes of patients＇ ICP at admission and ICP before decompressive craniectomy （ P 〈 0. 05）. However, there were no significant statistical differences of ICP after decompressive craniectomy （ P 〉 0. 05）. Conclusion Continuous invasive ICP monitoring has an important role in guiding the treat
出处
《中华神经外科杂志》
CSCD
北大核心
2013年第2期146-149,共4页
Chinese Journal of Neurosurgery
关键词
颅脑创伤
弥漫性脑肿胀
颅内压监测
预后
Craniocerebral trauma
Diffuse brain swelling
ICP monitoring
Prognosis
