动态监测颅内压在重型颅脑损伤临床治疗中的作用分析

李明升1，李录林2

（陕西省商洛市商南县医院：1.神经外科；2.外一科，陕西 商洛，726300）

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摘要：

目的 观察动态监测颅内压对重型颅脑损伤治疗的影响。方法 将86例重型颅脑损伤患者根据有无动态监测颅内压分为对照组（n=30）和观察组（n=56），均给予手术或药物治疗。对照组在治疗的同时行颅脑CT确定手术时机，观察组动态监测颅内压确定手术时机。比较两组治疗后GCS评分、甘露醇用量及使用时间，预后及不良反应、死亡情况。结果 观察组治疗后7天的GCS评分显著高于对照组，甘露醇用量、甘露醇使用时间显著少于对照组（P<0.05）。治疗后6个月，观察组预后良好比例显著高于对照组，不良反应总发生率、死亡率均显著低于对照组（P<0.05）。结论 对重型颅脑损伤患者给予动态监测颅内压，可指导医师及时行减压治疗，减少脱水剂使用剂量及时间，降低术后并发症发生率及死亡率。

关键词：动态监测；颅内压；重型颅脑损伤

中图分类号：R651.15文献标志码：A文章编号：2096-1413(2017)13-0099-02

Function analysis of dynamic monitoring of intracranial pressure in the treatment of severe craniocerebral injury
LI Ming-sheng 1, LI Lu-lin 2
(1. Department of Neurosurgery; 2. Department of Surgery, Shangnan County Hospital in Shangluo, Shangluo 726300, China)

ABSTRACT: Objective To observe the effect of dynamic monitoring of intracranial pressure on severe craniocerebral injury. Methods Eighty -six patients with severe craniocerebral injury were divided into control group (n =30) and observation group (n=56) according to whether accepted dynamic monitoring of intracranial pressure, and both groups were given surgery or medication. The control group used brain CT to determine the operation time, and dynamic monitoring of intracranial pressure was used in the observation group to determine the operation time. The GCS score, dosage and using time of mannitol, the prognosis, complications and deaths, incidence rate after treatment were observed in the two groups. Results The GCS score of the observation group after treated 7 d was significantly higher than that in the control group, the dosage and using time of mannitol were significantly lower than those in the control group (P<0.05). Six months after treatment, the observation group had a significantly higher proportion of good prognosis, and the total incidence rate of adverse reactions and mortality were significantly lower than those in the control group (P<0.05). Conclusion To give the dynamic monitoring of intracranial pressure in patient with severe craniocerebral injury can guide physicians in time decompression treatment, reduce the dosage and using time of mannitol and decrease the incidence of postoperative complications and mortality.
KEYWORDS: dynamic monitoring; intracranial pressure; severe craniocerebral injury

参考文献：
[1] 吴海权,柳浩然,辛续伟,等.有创颅内压监测在急性颅脑损伤术后的应用价值[J].右江医学,2016,44(1):121-122.
[2] 雷军,王飚,谢锐锋,等.早期颅内压监测在重型颅脑损伤手术中的应用[J].中国微侵袭神经外科杂志,2013,18(5):226-227.
[3] 刘国华,朱剑锋,刘树林.持续有创颅内压监测在重型颅脑损伤患者中的应用[J].临床合理用药,2012,5(1C):109-110.
[4] 钱令涛,杨春春,王永志,等.脑室内颅内压监测在老年颅脑损伤中的意义[J].中国临床神经外科杂志,2014,19(3):172-174.
[5] 李侠,李兵,杨黎,等.重型颅脑损伤术后有创颅内压监测的临床应用[J].解放军医学杂志,2011,36(12):1323-1325.
[6] 李志强,戴新连,沈冬青,等.颅内压监测在142例颅脑损伤危重患者中的应用[J].山东大学学报:医学版,2013,51(2):75-78.
[7] 王康,孙晓川,刘科.重型颅脑损伤颅内压监测临床研究进展[J].创伤外科杂志,2014,16(4):370-372,379.
[8] 梁玉敏,马继强,曹铖,等.颅脑损伤中颅内压监测:现状、争议和规范化应用[J].中国微侵袭神经外科杂志,2013,18(8):337-340.
[9] 李进京,罗光东,曹宴宾,等.中重度颅脑损伤后CT影像特点、颅内压与预后的关系[J].中国微侵袭神经外科杂志,2013,18(7):307-309.

[10] 江基尧.中国颅脑创伤颅内压监测专家共识[J].中华神经外科杂 志,2011,27(10):1073-1074.