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目的比较重型颅脑损伤术后不同的有创颅内压(ICP)监测方式对患者预后的影响,明确各种颅内压监测方式对重型颅脑损伤临床救治的意义。方法收集2009年1月-2010年6月接受手术治疗的201例重型颅脑损伤(STBI)病例,根据ICP探头的位置和放置方法分为A、B、C三组(每组67例),在常规手术的基础上分别于脑室、脑实质或硬膜下放置ICP监测探头。术后3～7d行腰穿,1次/d,记录脑脊液压力值及同时刻ICP监测仪显示的ICP值,计算两值之差并行组间比较。术后根据ICP值进行相应的脱水治疗,统计脱水剂使用的时间、剂量,手术操作时间,各种并发症发生率及患者预后,并进行组间比较。结果 A、B、C三组ICP监测值与脑脊液压力值的差值分别为22.4±3.6、20.8±4.1和12.3±11.5mmH2O。与A、B组比较,C组甘露醇使用时间和剂量显著增加(P<0.01),肺部感染和电解质紊乱的发生率显著升高(P<0.01),但三组患者的总体预后无显著差异。A组的手术操作时间显著长于B、C组(P<0.01),而B、C组手术时间无显著差异。结论持续有创颅内压监测所得ICP值较为稳定,是重型颅脑损伤救治的重要手段;脑实质内放置探头是较为有效的监测方式。
Objective To compare the effect of different methods of invasive intracranial pressure (ICP) monitoring on the prognosis of patients with severe craniocerebral injury and to clarify the significance of various methods of intracranial pressure monitoring in clinical treatment of severe craniocerebral injury. Methods 201 cases of severe head injury (STBI) undergoing surgery from January 2009 to June 2010 were collected and divided into three groups (A, B and C, 67 cases) according to the location and placement of ICP probe. Based on routine surgery, ICP monitoring probes were placed in the ventricle, parenchyma or subdural, respectively. The lumbar puncture was performed 3 to 7 days after operation, once per day. The cerebrospinal fluid pressure value and the ICP value displayed by the ICP monitor at the same time were recorded. The difference between the two values was calculated and compared between groups. The corresponding dehydration therapy was performed according to the ICP value after surgery. The time, dose, operation time, incidence of various complication and prognosis of the patients were counted and compared among groups. Results The difference between ICP and CSF pressure in groups A, B and C were 22.4 ± 3.6,20.8 ± 4.1 and 12.3 ± 11.5mmH2O, respectively. Compared with group A and group B, the time and dose of mannitol in group C increased significantly (P <0.01), the incidence of pulmonary infection and electrolyte disturbance increased significantly (P <0.01), but the overall prognosis of three groups was not significant difference. The operation time of group A was significantly longer than that of group B and C (P <0.01), while there was no significant difference between group B and C. CONCLUSIONS: The ICP obtained with continuous intracranial pressure monitoring is relatively stable and is an important treatment for severe craniocerebral injury. Probe placement in the brain parenchyma is an effective monitoring method.