颅内压监护下行腰大池引流在重型颅脑损伤术后的疗效观察

发布时间：2018-03-01 08:48

本文关键词： 颅内压监护腰大池引流重型颅脑损伤去骨瓣减压术　出处：《重庆医科大学学报》2017年10期 　论文类型：期刊论文

【摘要】：目的:探讨颅内压(intracranial pressure,ICP)监护下行腰大池置管引流在重型颅脑损伤开颅去骨瓣减压术后的治疗效果。方法:123例重型颅脑损伤开颅血肿清除去骨瓣减压术患者随机分为2组,其中73例患者在颅内压监护下行腰大池引流作为治疗组,50例患者只行腰大池引流作为对照组,通过观察2组患者甘露醇使用量、脑脊液引流量、并发症的发生率及6个月格拉斯哥预后评分(Glasgow outcome score,GOS)进行比较。结果:治疗组甘露醇使用量[(428.01±111.85)g]和使用时间[(4.52±1.54)d],对照组甘露醇使用量[(794.00±179.32)g]和使用时间为[(8.36±2.06)d]相比较差异有统计学意义(t=13.940,P=0.000;t=11.840,P=0.000)。治疗组脑脊液引流量为(1 180.40±174.63)m L,对照组脑脊液引流量为(1 663.58±213.61)m L,差异有统计学意义(t=13.750,P=0.000)。治疗组主要并发症(脑疝、二次出血、电解质紊乱、急性肾损伤)的发生率均低于对照组,差异有统计学意义(P0.05)。治疗组格拉斯哥预后评分恢复较好(恢复良好+轻度残疾)比率为63%,对照组恢复较好比率为44%,2组比较差异有统计学意义(χ~2=4.340,P=0.040)。结论:颅内压监护下行腰大池引流脑脊液在重型颅脑损伤去骨瓣减压术后的治疗效果优于单纯行腰大池持续引流。
[Abstract]:Objective: to investigate the effect of lumbar cistern drainage under intracranial pressure monitoring in patients with severe craniocerebral injury after craniotomy and craniotomy. Methods: one hundred and three patients with severe craniocerebral injury were randomly divided into two groups: one hundred and twenty-three patients with craniotomy and hematoma clearance and decompression. Among them, 73 patients were treated with lumbar cistern drainage under intracranial pressure monitoring as treatment group, 50 patients were treated with lumbar cistern drainage as control group, and the amount of mannitol and cerebrospinal fluid drainage were observed in two groups. The incidence of complications and the Glasgow outcome score were compared. Results: the mannitol usage and duration in the treatment group [428.01 卤111.85 g] and the control group [794.00 卤179.32 g] and the time of use [8.36 卤2.06 days] were compared. The cerebrospinal fluid drainage volume in the treatment group was 1 180.40 卤174.63 mL, and that in the control group was 1 663.58 卤213.61 mL. the difference was statistically significant. The main complications in the treatment group were cerebral hernia. The incidence of secondary bleeding, electrolyte disturbance and acute renal injury were lower than those in the control group. The difference was statistically significant (P 0.05). The recovery rate of Glasgow prognosis score in the treatment group was better than that of the control group (the recovery rate was better than that of the control group and the control group was 44%). Conclusion: intracranial pressure monitoring is a significant difference between the two groups (蠂 ~ 2, P = 24. 340, P = 0.040). The effect of cerebrospinal fluid drainage by lumbar cistern drainage in severe craniocerebral injury after decompression of bone flap was better than that of continuous lumbar cistern drainage alone.
【作者单位】：石家庄市第三医院神经外科;
【分类号】：R651.15

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