颅内压监测在脑外伤去骨瓣减压术后应用的效果评价

发布时间：2018-04-25 10:07

本文选题：重型颅脑损伤 + 颅内高压　；参考：《宁夏医科大学》2017年硕士论文

【摘要】：目的:探讨颅内压监测在重型颅脑损伤患者术后的临床应用效果,了解术后颅内压变化情况,指导颅脑损伤患者术后脱水药物的使用。方法:搜集2014年9月~2016年9月期间宁夏医科大学附属心脑血管医院重型颅脑损伤患者(GCS评分3~8分)23例作为研究对象,所有病人伤后24小时内入院,给予颅脑CT检查,均行单侧标准去骨瓣减压术。其中10例采用前瞻性研究,术后于额部骨窗旁硬膜下安放颅内压监测探头,另13例为同期重型颅脑损伤单侧标准去骨瓣减压术后未安放颅内压监测探头的病人。术后两组给予抑酸、补液等常规处理的同时,ICP监测组记录每小时颅内压数值,根据颅内压数值变化调整甘露醇用量,对照组按常规经验给予甘露醇,观察两组术后七天甘露醇总的用量、肾功能、水电解质紊乱情况以及术后七天监测组颅内压变化等情况。结果:1、ICP监测组甘露醇总用量为575.00±102.06g,对照组为815.38±163.47g,差异具有统计学意义(t=-4.319,P=0.000)。监测组甘露醇总使用时间为22.80±9.93天,对照组为25.08±11.30天,使用天数无明显差异(t=-0.504,P=0.619);2、ICP监测组肾功能不全1例,水电解质紊乱2例。对照组肾功能不全8例,水电解质紊乱9例,差异有统计学意义;3、通过持续观察监测组术后7天ICP的变化情况,发现ICP有一定的变化规律。且可能通过ICP变化判断患者病情是否进展及预后。大部分患者在术后4小时内ICP无明显升高,12小时内ICP升高至15~20 mm Hg左右,给予甘露醇脱水降颅压效果显著,ICP可有所下降或保持相对稳定;术后48小时左右患者颅内压数值开始出现高峰,大部分病人ICP数值达最高峰出现在术后的第3~5天,ICP波动在值在25~35mm Hg左右,有少部分病人ICP数值可达到35~40 mm Hg,给予脱水降颅压治疗后,ICP可有所下降并保持在相对稳定状态,查看患者生命体征都相对平稳。一般从第5天后开始逐渐回落。这些患者20天后的格拉斯哥预后评分2例良好,2例轻残,5例重残。1例患者在术后1~4小时即出现颅内压持续性升高,ICP值迅速增高至30~40 mm Hg,给予脱水降颅压等对症治疗后无明显改善,急查颅脑CT后发现手术部位再次出血,再次手术治疗,术后此例患者颅内压变化情况同前9例患者,20天后格拉斯哥预后评分为植物状态。4、术后20天格拉斯哥预后评分ICP监测组10例患者中2例(20%)良好,2例(20%)轻残,5例(50%)重残,1例(10%)植物状态;对照组13例患者中2例(15%)良好,4例(31%)轻残,6例(46%)重残,1例(8%)植物状态。从结果中我们可以看出对照组较监测组轻残患者多,但对比无统计学意义。结论:1、根据ICP监测的数据,能够有效的指导甘露醇的用量,同时降低了因脱水药物带来的急性肾功能不全、水电解质紊乱等一系列并发症的发病率,在一定程度上有助于患者的病情恢复。2、在重型颅脑损伤患者术后七天ICP具有一定的变化规律,一般于3~5天达到ICP高峰,通过ICP的高低及持续时间一定程度上可判断患者的病情及预后。3、在术后ICP监测可以有效地发现颅内压变化状况,为需再次手术的患者赢取了宝贵的治疗时间,可能对其预后产生良好的效果。
[Abstract]:Objective: To investigate the clinical effect of intracranial pressure monitoring in patients with severe craniocerebral injury after operation, to understand the changes of intracranial pressure after operation and to guide the use of dehydrating drugs after craniocerebral injury. Methods: 23 cases of severe craniocerebral injury (GCS score 3~8 score) in the affiliated cardio cerebral vascular Hospital of Ningxia Medical University in September 2014 and September were collected. As the study object, all patients were admitted to hospital within 24 hours after injury, and the CT examination was given to the craniocerebral, and the unilateral standard bone flap decompression was performed. 10 of them were prospectively studied, after the operation, the intracranial pressure monitoring probe was placed near the frontal bone window, and the other 13 cases were not monitored for intracranial pressure after the single side standard bone flap decompression for the same period of severe craniocerebral injury. The patients in the two groups were given the routine treatment of the two groups after the operation, such as acid suppression and rehydration, while the intracranial pressure values were recorded per hour, the mannitol was adjusted according to the changes in the intracranial pressure. The control group was given mannitol according to the routine experience. The total amount of mannitol in the two groups after seven days of operation, the renal function, the disorder of water and electrolyte and seven after operation were observed. Results: 1, the total amount of mannitol in the ICP monitoring group was 575 + 102.06g, the control group was 815.38 + 163.47g, and the difference was statistically significant (t=-4.319, P=0.000). The total use time of mannitol in the monitoring group was 22.80 + 9.93 days, the control group was 25.08 + 11.30 days, there was no significant difference (t=-0.504, P=0.619), 2, ICP. There were 1 cases of renal insufficiency in the monitoring group, 2 cases of water electrolyte disorder, 8 cases of renal insufficiency in the control group and 9 cases of water and electrolyte disorder, and the difference was statistically significant. 3, the changes of ICP in the 7 days after the operation of the monitoring group were observed continuously, and the change of ICP was found. And the prognosis of the patients was judged by ICP alteration. Most of the patients were diagnosed. There was no significant increase in ICP within 4 hours after operation, and ICP increased to 15~20 mm Hg in 12 hours. The effect of mannitol dehydration and reduction of cranial pressure was significant, and ICP decreased or remained relatively stable; the number of intracranial pressure in the patients began to peak at 48 hours after the operation, and the highest peak of ICP in most patients appeared on 3~5 days after operation and ICP fluctuation. At the value of 25~35mm Hg, a small number of patients had a ICP value of 35~40 mm Hg. After the dehydration and intracranial pressure treatment, ICP could be reduced and maintained in a relatively stable state. The patient's vital signs were relatively stable. Generally, the patients began to decline gradually from fifth days later. The prognosis of the patients in 20 days was good in 2 cases, and 2 cases were light. Residual intracranial pressure in 5 cases of severe disability.1 cases increased continuously at 1~4 hours after operation, ICP value increased rapidly to 30~40 mm Hg, and there was no obvious improvement after treatment with dehydration and craniocerebral pressure and other symptomatic treatment. After acute craniocerebral CT, the surgical site was re bleeding and reoperated, and the changes of intracranial pressure in this case were similar to those of the first 9 cases, 20 days later. The lasto prognosis score was plant state.4, 20 days after the operation, 2 cases (20%) were good, 2 cases (20%), 5 (50%) heavy disability, 1 (10%) plant state, and 1 cases (10%) in the ICP monitoring group, and 2 cases (10%) in the control group, and 2 cases (15%) in 13 cases in the control group. Compared with the monitoring group, there are many light disability patients, but there is no statistical significance. Conclusion: 1, according to the data of ICP monitoring, it can effectively guide the dosage of mannitol, and reduce the incidence of a series of complications, such as acute renal insufficiency caused by dehydrating drugs, water electrolyte disorder and so on, to some extent help the patient to recover.2, In patients with severe craniocerebral injury, ICP has a certain change rule on the seven day after operation, which generally reaches the peak of ICP on 3~5 days. The patient's condition and prognosis can be judged by the height and duration of ICP to a certain degree.3. The changes of intracranial pressure can be found effectively after the operation of ICP, and valuable treatment for the patients who need to be reoperated again. Time may have a good effect on its prognosis.

【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.15

【参考文献】