ICP联合TCD监测外伤性蛛网膜下腔出血的临床研究

发布时间：2018-04-13 04:06

本文选题：外伤性蛛网膜下腔出血 + 颅内压　；参考：《中国现代医学杂志》2017年01期

【摘要】：目的探讨脑室型颅内压(ICP)监测联合经颅多普勒(TCD)对外伤性蛛网膜下腔出血(t SAH)的治疗指导及预后判断。方法 45例t SAH患者入院后即行TCD动态监测及脑室型ICP探头置入术,术后持续ICP监测及脑脊液引流。依据ICP、TCD初始值制定患者的治疗策略。按脑血管痉挛程度分组,比较入院及术后6个月的Karnofsky功能状态评分,判定预后。结果 25例ICP初始值40 mm Hg,其中24例开颅手术,1例入手术室后出现中枢衰竭放弃手术。格拉斯哥预后评分死亡10例,植物生存4例,重残7例,中残2例,良好2例。ICP初始值20~40 mm Hg 8例,其中4例行开颅手术;植物生存1例,重残1例,中残1例,良好5例;ICP初始值15~20 mm Hg 12例,11例保守治疗,1例入院后第2天行手术治疗,均预后良好。开颅前后ICP、TCD变化比较,差异有统计学意义。ICP联合TCD对t SAH导致的无、轻及中度脑血管痉挛患者远期生活评分改善明显。结论早期连续ICP、TCD监测对指导t SAH患者的治疗有积极作用。
[Abstract]:Objective to investigate the therapeutic guidance and prognosis of traumatic subarachnoid hemorrhage (TSAH) with intracranial pressure monitoring (ICP) combined with transcranial Doppler imaging (TCD) in patients with traumatic subarachnoid hemorrhage.Methods 45 patients with t SAH underwent dynamic TCD monitoring and intraventricular ICP probe implantation immediately after admission, followed by continuous ICP monitoring and cerebrospinal fluid drainage.According to the initial value of ICPU TCD, the treatment strategy was established.According to the degree of cerebral vasospasm, the scores of Karnofsky function were compared between admission and 6 months after operation, and the prognosis was evaluated.Results the initial value of ICP was 40 mm / g in 25 cases, of which 24 cases underwent craniotomy and 1 case was given up with central failure after entering the operating room.Glasgow prognostic score included 10 cases of death, 4 cases of vegetative survival, 7 cases of severe disability, 2 cases of moderate disability, 2 cases of good ICP initial value of 2040 mm Hg, 4 cases of craniotomy, 1 case of vegetative survival, 1 case of severe disability, 1 case of middle disability.The initial value of ICP was 1520 mm Hg in 12 cases and conservative treatment in 11 cases. One patient received surgical treatment on the second day after admission and the prognosis was good.Before and after craniotomy, the difference was statistically significant. ICP combined with TCD could significantly improve the long-term life score of patients with mild and moderate cerebral vasospasm caused by t SAH.Conclusion early continuous monitoring of SAH plays a positive role in guiding the treatment of t SAH patients.
【作者单位】：湖南省常德市第一人民医院神经外科;
【分类号】：R651.15

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