中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2011年
6期
612-614
,共3页
郁树亮%陈华%叶泽鸿%陈培钊
鬱樹亮%陳華%葉澤鴻%陳培釗
욱수량%진화%협택홍%진배쇠
重型颅脑损伤%颅内压%监护
重型顱腦損傷%顱內壓%鑑護
중형로뇌손상%로내압%감호
Severe craniocerebral injury%Intracranial pressure%Monitoring
目的 探讨颅内压持续动态监护在重型颅脑损伤救治中的指导意义.方法 将我院2004年8月至2011年2月收治的124例重型颅脑损伤患者随机分为颅内压监护组(62例)和常规治疗组(62例).颅内压监护组根据颅内压的变化随时调整治疗方案,常规治疗组凭经验进行常规的神经外科治疗.结果 颅内压监护组并发急性肾功能衰竭7例,电解质紊乱11例;常规治疗组并发急性肾功能衰竭15例,电解质紊乱25例.颅内压监护组并发症发生率低(x2值为分别为3.54,7.67,P均<0.01).颅内压监护组及常规治疗组甘露醇使用时间分别为(6±2)、(15±3)d,使用剂量分别为(749±125)、(1545±250)g;恢复良好和轻残分别为28、16例,13、9例;重残、植物生存及死亡分别为9、17例,4、7例,8、13例;颅内压监护组较常规治疗组甘露醇使用时间短、剂量小(t值分别为8.32,7.41,P均<0.01),恢复良好和轻残比例高(x2值分别为5.07,3.55,P均<0.01),而重残、植物生存及死亡比例低(x2值分别为0.84,0.89,1.43,P均<0.01).结论 持续颅内压监护有利于早期指导和及时调整治疗措施,降低并发症,改善预后.
目的 探討顱內壓持續動態鑑護在重型顱腦損傷救治中的指導意義.方法 將我院2004年8月至2011年2月收治的124例重型顱腦損傷患者隨機分為顱內壓鑑護組(62例)和常規治療組(62例).顱內壓鑑護組根據顱內壓的變化隨時調整治療方案,常規治療組憑經驗進行常規的神經外科治療.結果 顱內壓鑑護組併髮急性腎功能衰竭7例,電解質紊亂11例;常規治療組併髮急性腎功能衰竭15例,電解質紊亂25例.顱內壓鑑護組併髮癥髮生率低(x2值為分彆為3.54,7.67,P均<0.01).顱內壓鑑護組及常規治療組甘露醇使用時間分彆為(6±2)、(15±3)d,使用劑量分彆為(749±125)、(1545±250)g;恢複良好和輕殘分彆為28、16例,13、9例;重殘、植物生存及死亡分彆為9、17例,4、7例,8、13例;顱內壓鑑護組較常規治療組甘露醇使用時間短、劑量小(t值分彆為8.32,7.41,P均<0.01),恢複良好和輕殘比例高(x2值分彆為5.07,3.55,P均<0.01),而重殘、植物生存及死亡比例低(x2值分彆為0.84,0.89,1.43,P均<0.01).結論 持續顱內壓鑑護有利于早期指導和及時調整治療措施,降低併髮癥,改善預後.
목적 탐토로내압지속동태감호재중형로뇌손상구치중적지도의의.방법 장아원2004년8월지2011년2월수치적124례중형로뇌손상환자수궤분위로내압감호조(62례)화상규치료조(62례).로내압감호조근거로내압적변화수시조정치료방안,상규치료조빙경험진행상규적신경외과치료.결과 로내압감호조병발급성신공능쇠갈7례,전해질문란11례;상규치료조병발급성신공능쇠갈15례,전해질문란25례.로내압감호조병발증발생솔저(x2치위분별위3.54,7.67,P균<0.01).로내압감호조급상규치료조감로순사용시간분별위(6±2)、(15±3)d,사용제량분별위(749±125)、(1545±250)g;회복량호화경잔분별위28、16례,13、9례;중잔、식물생존급사망분별위9、17례,4、7례,8、13례;로내압감호조교상규치료조감로순사용시간단、제량소(t치분별위8.32,7.41,P균<0.01),회복량호화경잔비례고(x2치분별위5.07,3.55,P균<0.01),이중잔、식물생존급사망비례저(x2치분별위0.84,0.89,1.43,P균<0.01).결론 지속로내압감호유리우조기지도화급시조정치료조시,강저병발증,개선예후.
Objective To discuss the meaning of continuous intracranial pressure (ICP) monitoring in patients with severe traumatic craniocerebral injury. Methods One hundred and twenty four patients with severe craniocerebral injury treated from August 2004 to February 2011 in our hospital, were enrolled and divided randomly into ICP monitoring group (n = 62) and routine treatment group (n = 62). The patients of ICP monitoring group had adjusted treatment plan according to the changes of ICP at any time, whereas the patients in routine treatment group underwent routine neurosurgical treatment according to the doctors' experience. Results There were 7 cases of acute kidney function failure,and 11 cases of electrolyte disturbances in the ICP group.There were 15 cases of acute kidney function failure, and 25 cases of electrolyte disturbances in the routine group. The complication rate in the ICP group was lower than that in the routine group (x2 =3. 54 and 7.67 for acute kidney function failure and electrolyte disturbances respectively, Ps <0. 01). The days of mannite using were (6±2)dand (15 ±3)d, respectively; the dosage of mannite using were (749 ± 125) g and (1545 ±250) g,respectively. The good recovery and slight disability were 28 and 16 cases in the ICP group, and 13 and 9 cases in the routine group,respectively. The severe disability,vegetative state and death were 9,4 and 8 cases in the ICP group,and 17,7 and 13 cases in the routine group. The days and dosage of mannite using in the ICP group were much less than those in the routine group (t = 8. 32 and 7.41, Ps < 0. 01). The proportion of good recovery and slight disability in the ICP group were higher than those in the routine group(x2 =5. 07 and 3. 55,Ps <0.01). However, the proportion of severe disability, vegetative state and death in the ICP group were lower than those in the routine group (x2 =0.84,0.89 and 1.43, Ps < 0. 01) . Conclusion Continuous ICP monitoring in severe craniocerebral injury shows benefits in directing treatment plan adjustment, reducing complications and improving the prognosis.
