颅内压监测对中重度颅脑损伤患者判断病情预后和指导治疗临床研究.docVIP

颅内压监测对中重度颅脑损伤患者判断病情预后和指导治疗临床研究 　　【摘要】 目的 探讨颅内压监测对中重度颅脑损伤患者判断病情预后与指导治疗方式。方法 80例急性颅脑损伤患者， 采用侧脑室导管测压法、脑组织内测压监护和硬脑膜外压力测定法， 持续对颅内压进行监测， 观察颅内压与格拉斯哥昏迷评分法（GCS）评分及预后的关系。结果 80例患者中颅内压监测正常的有8例， 另外72例患者均使用药物， 使用时间为2～14 d， 12例患者实施再次手术。颅内压的升高与GCS评分呈现负相关（r=-0.525、-0.713、-0.413、-0.264， P0.05）， 颅内压越高， 则GCS评分越低。不同颅内压患者预后比较差异具有统计学意义（P0.05）， 若患者的颅内压越高， 则预后越差。结论 针对中重度颅脑损伤病症采取颅内压监测有利于及时判断患者病情， 对患者的预后及治疗有重要临床意义， 值得临床推广及使用。 　　【关键词】 颅内压监测；颅脑损伤；临床效果 　　DOI：10.14163/j.cnki.11-5547/r.2017.18.002 　　【Abstract】 Objective To investigate disease prognosis judgment and treatment guidance by intracranial pressure monitoring for moderate and severe craniocerebral injury patients. Methods A total of 80 patients with acute craniocerebral injury all received continuous intracranial pressure monitoring by paracele catheter manometry， brain tissue manometry monitoring and exterior dura manometry. Observation was made on relationship between intracranial pressure， Glasgow coma scale （GCS） score and prognosis. Results Among 80 patients， there were 8 cases with normal intracranial pressure， and the other 72 cases all received drug therapy for 2～14 d. There were 12 cases received second operation. Increasing of intracranial pressure was negatively correlated with GCS （r=-0.525， -0.713， -0.413， -0.264， P0.05）， thus higher intracranial pressure led to lower GCS score. The difference of prognosis in patients with different intracranial pressure had statistical significance （P0.05）， and higher intracranial pressure caused worse prognosis. Conclusion Implement of intracranial pressure monitoring for moderate and severe craniocerebral injury is helpful to judge disease condition. This method shows important clinical significance for prognosis and treatment in patients， and it is worth clinical promotion and application. 　　【Key words】 Intracranial pressure monitoring； Craniocerebral injury； Clinical effect 　　?B脑创伤术后会引发颅内压增高， 最后致使病情恶化甚至死亡， 通过颅内压持续监测判断中重度颅脑损伤在临床上得到广泛应用。详细了解颅内压变化， 能够预防颅内高压造成脑组织不可逆性的损伤[1]。本次就2014年8月