上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

颅内压监测在急性重度颅脑外伤治疗中的应用

书国伟，费智敏，蔡佩浩，王静予，张 珏，邱 峰，孔令军，许乐宜，龚 立   

  1. 上海市中医药大学附属曙光医院神经外科， 上海 201203
  • 出版日期:2013-09-28 发布日期:2013-09-29
  • 通讯作者: 费智敏, 电子信箱: feizhimin@126.com。
  • 作者简介:书国伟（1973—）， 男， 主治医师， 硕士; 电子信箱: sgwcm20030627@163.com。

Application of intracranial pressure monitoring in  treatment of acute severe traumatic brain injury

SHU Guo-wei, FEI Zhi-min, CAI Pei-hao, WANG Jing-yu, ZHANG Jue, QIU Feng, KONG Ling-jun, XU Le-yi, GONG Li   

  1. Department of Neurosurgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
  • Online:2013-09-28 Published:2013-09-29

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摘要：

目的 探讨颅内压监测在急性重度颅脑外伤治疗中的作用。方法 选取64例急性重度颅脑外伤(sTBI)患者，采用颅内压监测治疗的资料，记录并分析治疗过程中颅内压（ICP）、脑灌注压（CPP）、格拉斯哥昏迷评分（GCS）和格拉斯哥结果评分（GOS）的数值。结果 52例sTBI患者的影像学资料存在手术指征,直接行血肿清除术和（或）标准大骨瓣减压术+ICP监测;12例sTBI患者无影像学手术指征，行ICP脑室监测。术后24 h ICP、CPP与72 h相比差异无统计学意义（P>0.05）；入ICU时与术后24 h、术后24 h与术后72 h、术后72 h与出ICU时的GCS相比差异均有统计学意义（P<0。05）；出院时GOS值平均（4.13±0.72）分，无死亡和植物状态。结论 ICP监测在治疗重症急性颅高压时有应用价值。

关键词: 急性重度颅脑外伤, 颅高压, 颅内压监测

Abstract:

Objective To investigate the effect of management with intracranial pressure (ICP) monitoring in acute severe traumatic brain injury. Methods Sixty-four patients with acute severe traumatic brain injury managed with ICP monitoring were selected, and the values of ICP, cerebral perfusion pressure (CPP), Glasgow coma scale (GCS) and Glasgow outcome scale (GOS) were recorded and analyzed. Results Fifty-two patients with surgical indication underwent hematoma removal and/or decompressive craniectomy with ICP monitoring, and the other 12 patients without surgical indication received ICP monitoring with ventricular catheter. There was no significant difference between the values of ICP and CPP 24 h after operation and those 72 h after operation (P>0.05). There were significant differences between the value of GCS on ICU admission and that 24 h after operation, between the value of GCS 24 h after operation and that 72 h after operation, and between the value of GCS 72 h after operation and that on ICU discharge (P<0.05 for all). The mean value of GOS was (4.13±0.72), and no death and vegetative state
occurred. Conclusion Management with ICP monitoring is effective in acute severe traumatic brain injury.

Key words: acute severe traumatic brain injury, intracranial hypertension, intracranial pressure monitoring