颅内压监测阶梯治疗方案治疗继发严重外伤性脑水肿.pdfVIP

. 132. 中华神经外科杂志2012 年2 月第28 卷第2 期 Chin J Neurosurl!:. February 2012. Vol. 28. No.2 ·颅脑创伤· 颅内压监测阶梯治疗方案治疗继发 严重外伤性脑水肿 金毅高亮胡锦韩唏吴惺吴雪海 [摘要] 目的 探讨颅内压监测下的阶梯治疗方案对于严重外伤性脑水肿的治疗有效性。 方法 24 例入院评分 GCS 14 或 15 分的轻度颅脑损伤患者继发严重脑水肿，经有创颅内压监测，阶 梯治疗方案有效控制高颅压，缓解脑水肿。结果 颅内压监测下的阶梯治疗安全有效地治疗此病例 组的脑水肿和高颅压，其中 14 例子术清除血肿去骨瓣减压，10 例仅阶梯治疗就良好控制颅内压，所 有病例组无死亡和严重并发症，3 个月后随访所有病例 GOS 评分均为5 分。结论 颅内压监测下阶 梯治疗方案在控制轻度颅脑损伤患者继发严重脑水肿是有效的;颅内压是此类患者治疗重要的监测 标准。 [关键词] 外伤性脑损伤; 颅内压监测; 预后 A protocol of stepwise therapy for patients after TBI under ICP monitoring ]IN Yi , GAO Liang ,HU ]in ,HAN Xi , WU Xing , WU Xue-hai. Department of Neurosurgery , Huashan Hospital ~伊liated to Fudan Univercity , Shanghai 200040 , China Corresponding author: GAO Liang [ Abstract] Objective To verify the step - wise therapy under ICP monitoring is effective on seve陀 brain edema after TB I. Me仙。ds 24 cases with mild TBI with GCS score 14 or 15 had severe brain edema All these edema cases had been controlled under stepwise therapy and intensive ICP monitoring. Results 14 of 24 cases with severe edema underwent decompression and 10 of which without. All cases recovered smoothly and had no mortality and morbidity , or even severe complication. All the patientsGOS scores after 3 months were 5. Conclusions The step - wise therapy under ICP monitoring is effective and safe for severe edema of mild TBI patients. ICP is the most important standard for mild edema after TB I. [Key words] Traumatic brain injury; Intracranial pressure monitori吨; Prognosis 颅脑创伤后急性脑内血肿和脑水肿造成的颅内 明确外伤史。伤后影像学检查，CT 发现颅内单发或 高压的病理过程，往往需要于术干预。特别对于继 多发血肿或脑挫裂伤，但是范围和体积尚未达到 发性脑水肿，病情恶化后常须去骨瓣减压手术，但是 《中国颅脑创伤外科手术指南}[2] (以下简称《指 依据影像变化或者症状变化，