重型颅脑损伤患者有创颅内压监测联合脑室外引流应用研究.docVIP

重型颅脑损伤患者有创颅内压监测联合脑室外引流应用研究 　　[摘要] 目的 探讨有创颅内压监测技术联合脑室外引流在重型颅脑损伤患者中的临床应用价值。 方法 选取2012年1月～2014年1月茂名市人民医院神经外科200例重型颅脑损伤患者，按照随机数字表法将其分为监测组和对照组，每组各100例。监测组于入院后行有创颅内压监测；对照组依据患者意识、生命体征和CT检查等，进行常规治疗。观察术后颅内压与格拉斯哥昏迷评分（GCS）的关系，观察术后第1天脱水前颅内压、6个月后预后情况，记录两组患者脱水剂应用时间、剂量，常见并发症及转归，并分析比较两组各项结果。 结果 监测组患者中颅内压正常者GCS为（13.14±1.35）分，颅内压轻度增高者GCS为（9.27±1.56）分，颅内压中度增高者GCS为（6.39±2.29）分，颅内压重度增高者GCS平均分为（4.36±1.88）分，颅内压与GCS评分呈负相关（r = -0.836，P 0.05）；监测组的预后良好率（67.0%）明显高于对照组（46.0%），而病死率（19.0%）明显低于对照组（32.0%），差异均有统计学意义（χ2=5.130、5.973，均P 0.05）。 结论 有创颅内压监测技术能动态观察神经外科患者的颅内压变化情况，有利于及时采取脑室外引流有效治疗控制颅内压，改善患者预后，值得临床推广应用。 　　[关键词] 神经外科；重型颅脑损伤；有创颅内压监测；预后 　　[中图分类号] R651.15 [文献标识码] A [文章编号] 1673-7210（2015）07（b）-0048-05 　　[Abstract] Objective To study the clinical application value of the invasive intracranial pressure monitoring combined with external ventricular drainage in patients with severe craniocerebral injury. Methods From January 2012 to January 2014， in Department of Neurosurgery， Maoming Peoples Hospital， 200 patients with severe craniocerebral injury were selected， according to random number table they were divided into monitoring group and control group， with 100 cases in each group. Monitoring group was given the invasive intracranial pressure monitoring after admission； control group was given conventional therapy according to patients conscious， vital signs and CT examination. The intracranial pressure （ICP）， Glasgow coma scale （GCS） after the surgery， ICP in the first day after surgery to before dehydration， the prognosis after 6 months of two groups were observed， ehydrating agent application time and dose， common complications and outcome of two groups were recorded， the results were compared and analyzed. Results In monitoring group， GCS of normal ICP patients were （13.14±1.35） scores， GCS of slightly increased ICP patients were （9.27±1.56） scores， GCS of moderately increased ICP were （6.39±2.29） scores， GCS of heavy increased ICP patients were （4.36±1.88） scores， there was a negative cor