[1]刘科峰,吴智远,龚坚,等.有创颅内压监测和阶梯式治疗进展性脑挫裂伤[J].临床神经外科杂志,2014,(05):363-366.
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有创颅内压监测和阶梯式治疗进展性脑挫裂伤()
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《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:
期数:
2014年05期
页码:
363-366
栏目:
论著
出版日期:
2014-10-31

文章信息/Info

Title:
Invasive intracranial pressure monitoring and stepwise management of progressive cerebral contusion
作者:
刘科峰 吴智远 龚坚 文世宏
南京医科大学附属常州第二人民医院神经外科
关键词:
颅脑外伤脑挫裂伤颅内压监测治疗预后
Keywords:
Traumatic brain injuries Cerebral contusion Intracranial pressure Monitoring Management Outcome
分类号:
R651.1
文献标志码:
A
摘要:
目的 探讨有创颅内压监测技术持续监测颅脑外伤后进展性脑挫裂伤颅内压变化,及采用阶梯式治疗方案控制颅高压的治疗效果。方法 回顾性分析我院2008年1月-2013年10月收治的21例颅脑外伤后幕上进展性脑挫裂伤患者,采用硬膜下探头和额角穿刺脑室内探头置入持续监测颅内压,以控制ICP为目标导向,运用阶梯式治疗方案降低颅内压 ,改善该类型颅脑外伤患者的预后。结果 本组资料21例患者均成功置入颅内压监测探头。置入硬膜下探头3例,脑室内探头18例。初次ICP 9-41mmHg(26.90±10.83 mmHg),采用阶梯式治疗方案控制ICP<20mmHg。9例患者初次ICP 26-41mmHg(34.00±5.35 mmHg)行开颅手术;12 例ICP 8-25mmHg(15.32±6.32 mmHg)采用保守治疗,其中有8例患者在保守治疗过程中ICP持续上升大于25mmHg30分钟行开颅手术。手术组术前ICP 26-41mmHg(32.00±5.35 mmHg),术后ICP 5-14mmHg(10.77±5.28 mmHg),P<0.05,开颅手术对于降低颅内压效果显著。6个月后的GOS评分5分13例,4分8例。结论 有创颅内压监测能客观、准确和及时反应进展性脑挫裂伤患者的颅内压变化。阶梯式治疗方案有效降低颅内压,改善预后。
Abstract:
Objective To discuss invasive intracranial pressure monitoring for progressive cerebral contusion patients, and effectiveness of stepwise management of elevated Intracranial pressure. Methods A retrospective analysis of 21 cases of progressive cerebral contusion admitted at our hospital from January 2008 to October 2013. In order to control the ICP as the goal guidance, a subdural or ventriculostomy catheter was implanted and intracranial pressure was measured continuously. The stepwise management was adopted to reduce intracranial pressure and to improve the prognosis of patients with this type of traumatic brain injury. Results 21 patients were successfully implanted intracranial pressure monitoring catheter. 3 cases were implanted subdural catheter, and ventriculostomy catheter in 18 cases. The first ICP 9-41mmHg (26.90 ± 10.83 mmHg), using stepwise therapy for controlling ICP less than 20mmHg.In 9 patients with primary ICP 26-41mmHg (34 ± 5.35 mmHg) underwent craniotomy operation.12 cases of ICP 8-25mmHg (15.32 ± 6.32 mmHg) with the conservative treatment, including 8 patients in the conservative treatment of ICP continued to rise more than 25mmHg for 30 minutes underwent decompressive craniectomy. Preoperative ICP 26-41mmHg (32 ± 5.35 mmHg), postoperation 5-14mmHg (10.77 ± 5.28 mmHg), P<0.05, craniotomy operation effectively reduced intracranial pressure. According to GOS for assessment of outcome, 5 point in 13 cases, and 4 point in 8 cases .Conclusion Invasive intracranial pressure monitoring can objectively, accurately and timely response to changes of intracranial pressure with progressive cerebral contusion patients. The stepwise management effectively reduces intracranial pressure, improving the prognosis.

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备注/Memo

备注/Memo:
[收稿日期] 2013-12-14
更新日期/Last Update: 2014-10-15