有创动态颅内压监测对中重度颅脑损伤患者的临床应用价值分析

发布时间：2018-05-18 00:10

本文选题：颅内压监测 + 颅脑损伤　；参考：《大连医科大学》2017年硕士论文

【摘要】：背景:颅脑损伤(traumatic brain injury,TBI)是指因外界暴力直接或间接地作用到头部而引起的包括头皮、颅骨和脑实质在内的各种头颅组织损伤,其发生率居各型创伤首位。颅内压增高作为TBI最常见的并发症,是反映患者病情严重程度的重要指标,尤其是中重度急性颅脑损伤中因出血、水肿等继发性脑损伤所引起的急性ICP增高,是颅脑创伤中最严重的一种,是造成患者病情急剧恶化、预后不佳以及致死致残的主要原因。因此,在诊治TBI患者过程中,ICP的变化一直是神经外科医生的关注重点。自1960年Lundberg等人开始将ICP监测应用于实际诊治当中【1】,至今已有半个多世纪的历程,其应用越来越广泛。目前,尽管ICP监测已经被国内外学者广泛认可并应用于临床治疗,但仍然不断有研究结果对其疗效提出不甚相同至截然相反的结论。因此,需要更加全面准确的回顾性分析以及更加严谨的临床实验来明确颅内压监测在中重度TBI患者治疗中所起的作用及意义,从而为临床治疗起到积极的指导作用。目的:探讨有创动态ICP监测对指导中重度TBI患者临床治疗的应用价值。方法:本研究选择大连医科大学附属第二医院神经外科2015年07月至2016年09月期间收治的105例中重度TBI患者,并随机把入选患者分为实验组(54例)和对照组(51例)。对照组采用传统方式对颅内压水平进行判定,给予常规神经外科处置,另一组为实验组,均施行有创动态ICP监测,根据ICP监测的结果来指导制定进一步临床干预方案。比较实验组和对照组患者的性别、年龄、肾功能、TBI严重程度等一般资料的差异未见统计学意义(P0.05),具有可比性。最终比较两组患者住院死亡率、甘露醇剂量及使用时间、相关并发症发生率和预后情况四方面的对比结果,从而明确给中重度TBI患者施行有创动态ICP监测是否具有指导意义。结果:实验组在整个治疗过程中住院死亡率稍低于对照组,但所使用脱水剂用量及天数、相关并发症发生率均显著比对照组要好(P0.01);出院后6个月患者的预后GOS评分也比对照组好(P0.05)。结论:对中重度TBI患者实施有创动态ICP监测,能及时、精准、客观地反映患者的病情进展,能为颅内压增高导致病情恶化提供早期预警,争取宝贵的治疗时间,便于针对不同个体及时采用有针对性的干预措施,有效消除治疗上的盲目性,降低相关并发症的发生率,并显著改善患者预后。因此,总的来说,对中重度TBI患者实行ICP监测利远远大于弊,对临床诊治工作具有重要的指导意义,值得推广。
[Abstract]:Background: traumatic brain injury (TBI) refers to all kinds of cranial tissue injuries, including scalp, skull and brain parenchyma, caused by external violence directly or indirectly to the head. Intracranial hypertension, as the most common complication of TBI, is an important index to reflect the severity of the patient's condition, especially the increase of acute ICP caused by secondary brain injury such as hemorrhage and edema in moderate and severe acute craniocerebral injury. It is the most serious type of traumatic brain injury. It is the main cause of rapid deterioration, poor prognosis and death and disability in patients with craniocerebral trauma. Therefore, in the diagnosis and treatment of TBI patients, the changes of ICP has been the focus of neurosurgeons. Since 1960, Lundberg et al. began to apply ICP monitoring to actual diagnosis and treatment [1]. It has been more than half a century since then, and its application is more and more extensive. At present, although ICP monitoring has been widely recognized by domestic and foreign scholars and used in clinical treatment, there are still a number of research results on its efficacy is not the same or the opposite conclusion. Therefore, more comprehensive and accurate retrospective analysis and more rigorous clinical trials are needed to clarify the role and significance of intracranial pressure monitoring in the treatment of moderate and severe TBI patients, so as to play a positive guiding role in clinical treatment. Objective: to evaluate the value of invasive dynamic ICP monitoring in guiding the clinical treatment of moderate and severe TBI patients. Methods: 105 patients with moderate and severe TBI were selected from Neurosurgery Department of the second affiliated Hospital of Dalian Medical University from July 2015 to September 2016. The patients were randomly divided into two groups: experimental group (54 cases) and control group (51 cases). In the control group, the level of intracranial pressure was judged by traditional method, and the routine neurosurgical treatment was given to the other group. The other group was treated with invasive dynamic ICP monitoring. According to the results of ICP monitoring, the further clinical intervention scheme was established. There was no significant difference in sex, age and TBI severity between the experimental group and the control group (P 0.05). Finally, the hospital mortality rate, mannitol dosage and time of use, the incidence of related complications and prognosis were compared between the two groups, so as to determine the significance of dynamic ICP monitoring in patients with moderate and severe TBI. Results: the inpatient mortality rate in the experimental group was slightly lower than that in the control group, but the dosage and days of dehydrating agent used in the experimental group were lower than those in the control group. The incidence of related complications was significantly better than that of the control group (P 0.01), and the prognosis GOS score of the patients at 6 months after discharge was also better than that of the control group (P 0.05). Conclusion: the application of invasive dynamic ICP monitoring in moderate and severe TBI patients can reflect the progress of the patient's condition in time, accurately and objectively, and can provide early warning for the exacerbation of the condition caused by increased intracranial pressure and gain valuable treatment time. It is convenient for different individuals to use timely targeted intervention measures, effectively eliminate blindness in treatment, reduce the incidence of related complications, and significantly improve the prognosis of patients. Therefore, in general, the advantages of ICP monitoring for moderate and severe TBI patients are far greater than the disadvantages, which has important guiding significance for clinical diagnosis and treatment, and is worth popularizing.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.15

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