摘要
目的 观察有创颅内压（ICP）监测对重型颅脑损伤（STBI）患者术后治疗的指导作用.方法 将142例STBI患者随机分为观察组及对照组各71例,两组均行颅内血肿清除术.观察组采用颅内监测探头置入术ICP监测,对照组采用闪光视觉诱发电位进行无创性ICP动态监测.在常规止血、防治上消化道出血等治疗的同时,如ICP＞ 15 mmHg超过30 min,即用20％甘露醇脱水,同时予镇静,保持呼吸道通畅,抬高头位30°,每日补液量2000～2 500 mL,有创颅内压监护同时引流脑脊液.如ICP继续升高,＞30mmHg,多提示颅内血肿增加或发生了较严重的脑水肿,应及时复查CT并做相应处理.观察两组甘露醇应用时间、剂量及术后第1、3、5天的ICP变化.结果 观察组甘露醇平均应用时间为7d,平均剂量为1 125 g；对照组分别为12 d、1 420 g,两组比较P均＜0.05.与对照组比较,观察组术后第3、5天ICP水平减低（P均＜0.05）.结论 有创ICP监测能准确反映STBI患者术后ICP变化,有助于指导临床用药.
Objective To observe the effect of invasive intracranial pressure （ICP） monitoring for postoperative treatment of patients with severe traumatic brain injury （STBI）.Methods A total of 142 patients with STBI were randomly divided into two groups,71 in each group：the observation group and the control group.All patients underwent intracranial haematoma cleaning,and then the observation group and control group were respectively treated by intracranial monitoring probe implantation and flash visual evoked potential （FVEP）.Besides the routine hemostatic,prevention and treatment of upper digestive tract bleeding,if ICP ＞ 15 mmHg for more than 30 min,dehydration was conducted with 20％ mannitol as well as calming,maintaining airway patency and raising the head 30°,the daily volume of fluid infusion was 2000-2500 mL,with ICP monitoring and drainage of cerebral spinal fluid; if ICP continued to rise,more than 30 mmHg,which showed intracranial hematoma increased or the occurrence of serious cerebral edema,we should timely review CT and make corresponding processing.The application time,dose of mannitol,and change of ICP after operation for 1 st,3rd and 5th day were observed in the two groups.Results The mean application time of mannitol was 7 d,and mean dose was 1 125 g in the observation group,while 12 d and 1 420 g in the control group （all P ＜ 0.05）.ICP at 3rd,5th day after operation was significantly decreased in the observation group as compared with that of the control group （all P ＜ 0.05）.Conclusion Invasive ICP monitoring by intracranial monitoring probe implantation can accurately reflect the changes of ICP in patients with STBI after operation,and help to guide clinical medication.
出处
《山东医药》
CAS
2013年第39期37-39,共3页
Shandong Medical Journal
基金
上海市卫生局立项课题(20124Y140)
关键词
颅内监测探头置入术
重型颅脑损伤
有创性颅内压监测
intracranial monitoring probe implantation
severe brain injury
invasive intracranial pressure monitoring
