摘要
目的探讨颅脑创伤患者颅内压波形中纺锤波的临床意义及其发生机制。方法回顾性纳入2016年3月至2016年12月上海交通大学附属仁济医院神经外科收治的50例颅脑创伤患者。所有患者均行颅内压监测。50例患者中，出现纺锤波18例（试验组），未出现纺锤波32例（对照组）。比较两组的出院格拉斯哥昏迷评分（GCS）、住院时间以及随访3个月时的格拉斯哥预后分级（GOS），并分析出现纺锤波时颅内压波形各参数的变化。结果试验组出院时GCS评分[（12．83±2．04）分]高于对照组[（10．84±3．77）分]（P〈0．05），3个月后预后良好（GOSIV～V级）的比率（61％）大于对照组（31％）（P〈0．05）。试验组的住院时间少于对照组1分别为（18．4±4．5）d和（22．2±7．1）d，P〈0．05]。与纺锤波出现前相比，纺锤波出现后患者的平均颅内压、颅内压脉搏波的波幅、波幅与颅内压的相关系数均下降（均P〈0．05）。结论纺锤波的出现可能与颅脑创伤患者的良好预后相关；其原因可能与纺锤波出现时，颅内压、脑顺应性、脑代偿空间的生理参数均呈现明显改善有关。
Objective To describe the features of spindle waves during intracranial pressure waveform monitoring in patients with traumatic brain injury and to investigate its significance and mechanism. Methods Clinical. data of 50 patients with traumatic brain injury were retrospectively analyzed who were admitted to Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine from March 2016 to December 2016. All 50 patients underwent ventricular puncture and intracranial pressure （ICP） monitoring. Among them, 18 cases showed spindle waves and were assigned to the test group, while the remaining 32 patients in control group did not demonstrate spindle waves. The patientg Glasgow coma scale （GCS） at discharge, length of stay and Glasgow outcome scale （GOS） at 3 months post injury were compared between the 2 groups. Various parameter changes of ICP waveform were analyzed in case of spindle waves. Results Compared with control group, the patients with spindle waves tended to have a higher GCS at discharge（ 12.83 ±2.04 vs. 10.84±3.77, P 〈 0.05 ）, a larger proportion of good recovery （ GOS IV - V ） （61% vs. 31%, P 〈 0.05 ）, and a shorter length of stay[ （ 18.4 ±4.5） d vs. （22.2 ± 7.1 ） d , P 〈 0.05 ） ]. Furthermore, compared with the parameters before the occurrence of spindle wave, the parameters during the time of spindle wave, including mean ICP, pulse amplitude of ICP, regression of amplitude and pressure coefficient, demonstrated significant improvement （ all P 〈 0.05 ）. Conclusions The spindle wave in ICP waveform seems to be associated with good outcomes in patients with traumatic brain injury. During the appearance of spindle wave, physiological parameters such as ICP, brain compliance and compensatory capacity showed significant improvement, which may lead to the enhancement of clinical outcomes.
出处
《中华神经外科杂志》
CSCD
北大核心
2017年第7期660-664,共5页
Chinese Journal of Neurosurgery
基金
国家自然科学基金（81671198）
上海市高峰计划研究型医师项目（20152212）
关键词
颅脑损伤
预后
颅内压
纺锤波
Craniocerebral trauma
Prognosis
Intracranial pressure
Spindle wave
