摘要
目的探讨持续有创颅内压(ICP)监测在创伤性急性弥漫性脑肿胀(PADBS)治疗中的临床意义。方法对113例PADBS患者行ICP监测,根据监测结果指导治疗,并对其预后进行统计分析。结果113例患者中,32例颅内压正常或轻度升高(ICP 15~22 mmHg)者予以神经重症综合治疗后均恢复良好;31例颅内压中度升高(ICP 23~40 mmHg)者均予以神经重症综合治疗等措施有效控制颅内压,恢复良好17例,轻残9例,重残5例;50例颅内压重度升高(ICP>40 mmHg)者予以神经重症综合治疗后,其中24例行单侧开颅血肿清除和去骨瓣减压术,恢复良好15例,重残5例,植物状态3例,死亡1例;26例予以双侧开颅去骨瓣减压术治疗,恢复良好5例,轻残2例,重残5例,植物状态8例,死亡6例。随着颅内压升高,患者GOS预后评分逐渐下降(P<0.001)。结论ICP监测在PADBS治疗中可动态了解颅内压并进行有效监控,避免了不必要的去骨瓣减压术,降低重残率和病死率,提高治愈率。
Objective To evaluate the application of continuous invasive intracranial pressure(ICP)monitoring in the treatment of posttraumatic acute diffuse brain swelling(PADBS).Methods A total of 113 PADBS patients underwent ICP monitoring and treated according to the monitoring results,and their prognosis was retrospectively analyzed.Results In the current study,32 patients with normal or mildly elevated intracranial pressure(ICP 15—22 mmHg)underwent comprehensive treatment of neurological severity and all recovered well.Then,31 patients with moderately increased intracranial pressure(ICP 23—40 mmHg)were given comprehensive treatment of neurological severity and their intracranial pressure was effectively controlled,including 17 cases with good recovery,9 cases who were mildly disabled,and 5 cases who were severely disabled.There were 50 patients with severely increased intracranial pressure(ICP>40 mmHg)who underwent comprehensive treatment of neurological severity,where 24 patients underwent unilateral craniotomy and decompression surgery,with 15 good recovery cases,5 severely disabled cases,3 cases in the vegetative state and 1 case of death.The other 26 patients underwent bilateral craniotomy decompression,including 5 good recovery cases,2 cases who were mildly disabled,5 cases who were severely disabled,8 cases in the vegetative state,and 6 cases of death.Conclusions The use of ICP monitoring in PADBS treatment can dynamically understand the changes in intracranial pressure,avoid unnecessary bilateral frontal-temporal cranial bone decompression,reduce its severe disability rate and mortality,and improve the cure rate.
作者
蔡湛
范月超
单学仕
王健
CAI Zhan;FAN Yuechao;SHAN Xueshi;WANG Jian(Graduate School,Xuzhou Medical University,Xuzhou,Jiangsu 221004,China;Department of Neurosurgery,the Affiliated Hospitalof Xuzhou Medical University,Xuzhou,Jiangsu 221002;Department of Neurosurgery,Ruihua HospitalAffiliated to Soochow University,Suzhou,Jiangsu215104)
出处
《徐州医科大学学报》
CAS
2021年第9期672-676,共5页
Journal of Xuzhou Medical University
关键词
重型颅脑损伤
颅内压监测
创伤性急性弥漫性脑肿胀
预后
神经重症综合治疗
severe craniocerebral injury
intracranial pressure monitoring
traumatic acute diffuse brain distension
prognosis
comprehensive treatment of neurological severity
