持续颅内压监测在高龄对冲性额叶挫裂伤伴迟发性脑内血肿中的意义.docVIP

持续颅内压监测在高龄对冲性额叶挫裂伤伴迟发性脑内血肿中的意义 　　沈阳军区总医院神经外科，辽宁沈阳 110016 　　[摘要] 目的 探讨持续颅内压（intracranial pressure，ICP）监测在高龄对冲性额叶挫裂伤伴迟发性脑内血肿的意义，指导临床治疗。 方法 回顾性分析2012年3月～2013年2月于沈阳军区总医院治疗的对冲性额叶挫裂伤伴迟发性脑内血肿的患者27例。所有患者均为年龄大于70岁的高龄患者。15例患者于受伤24～72 h后进行ICP监测，作为A组，平均时间（5.4±1.5） d。12例患者未进行ICP监测，作为B组。A组患者ICP监测持续升高20 mm Hg（1 mm Hg=0.133 kPa），甚至25 mm Hg，应用脱水药物控制不理想，且患者意识进行性下降、连续头部CT平扫提示脑内血肿增加或脑水肿进行性加重的患者建议手术治疗。B组未应用ICP监测的患者出现以上症状也建议手术治疗。比较AB两组的预后：治疗后3个月随访，预后情况采用GCS评分分级进行比较。 结果 A组预后良好8例，中残4例，病死3例。B组预后良好3例，中残2例，重残2例，病死5例。A组较B组预后良好率高，差异有统计学意义（P 0.05）。 结论 持续ICP检测可判断和预测病情变化、提高早期手术的机会，值得在颅脑损伤颅内出血的治疗过程中广泛应用。 　　[关键词] 持续颅内压检测；高龄；对冲性额叶挫裂伤；脑内血肿 　　[中图分类号] R651.15 [文献标识码] C [文章编号] 1673-7210（2013）11（b）-0158-03 　　Significance of the continuous intracranial pressure monitoring in older patients of forehead contrecoup injury with late-onset brain hematoma 　　TAO Yingqun LI Zhiyong XU Feng WEN Liang ZHANG Youqian JIANG Wei 　　Department of Neurosurgery， General Hospital of Shenyang Military Area Command， Liaoning Province， Shenyang 110016， China 　　[Abstract] Objective To study the significance of the continuous intracranial pressure monitoring in older patients of forehead contrecoup injury with late-onset brain hematoma， aiming to guide clinical treatment. Methods A retrospective analysis of 27 patients of forehead contrecoup injury with late-onset brain hematoma from March 2012 to February 2013 treated in General Hospital of Shenyang Military Area Command. All the patients were older than 70-year-old. 15 patients taking the intracranial pressure （ICP） monitor after injured 24～72 h were chosen as group A， the average time was （5.4±1.5） days. 12 patients not taking ICP monitoring were chosen as group B. Group A： ICP monitoring patients of group A′s ICP 20 mm Hg （1 mm Hg=0.133 kPa） or 25 mm Hg， dehydration drug control wasn′t ideal and patients had decreased in consciousness， the continuous head CT scan prompted the brain hematoma increasing or cerebral edema progression of patients， suggesting that t