CAJ | 학술논문

目的探讨有创颅内压(ICP)监测对治疗创伤性急性双侧半球弥漫性脑肿胀的指导作用以及判断预后的意义.方法 2010年2月至2011年10月湖州市解放军第98医院神经外科在有创ICP监测下治疗创伤性急性双侧半球弥漫性脑肿胀59例,前瞻性研究患者入院时ICP、去骨瓣减压患者术前ICP和术后ICP等临床资料,按伤后6个月的GOS评分分为恢复良好组(GOS4 ～5分)和恢复不良组(GOS 1 ～3分).探讨入院时ICP、去骨瓣减压患者术前ICP、术后ICP与预后的关系.结果本组病例恢复良好率69％ (41/59),恢复不良率31％ (18/59),病死率15％ (9/59).入院时GCS≥9分的患者预后无死亡及植物生存,入院时GCS 13～14分的患者均恢复工作或学习(GOS5分).在持续有创ICP监测下29例施行了去骨瓣减压术.入院时ICP、去骨瓣减压患者术前ICP和术后ICP恢复良好组分别是(22.2 ±7.9)mm Hg、(31.9±9.5)mm Hg和(12.3 ±2.9)mm Hg；恢复不良组分别是(33.4±18.9) mm Hg、(43.7±14.6)mm Hg和(13.0±5.6) mm Hg.两组指标相对应比较,患者入院时ICP、去骨瓣减压患者术前ICP差异有统计学意义(P＜0.05),去骨瓣减压患者术后ICP差异无统计学意义(P＞0.05).结论持续有创ICP监测对创伤性急性双侧半球弥漫性脑肿胀的治疗有重要的指导作用,此类患者的预后与入院时ICP、去骨瓣减压患者术前ICP有关.
목적 탐토유창로내압(ICP)감측대치료창상성급성쌍측반구미만성뇌종창적지도작용이급판단예후적의의.방법 2010년2월지2011년10월호주시해방군제98의원신경외과재유창ICP감측하치료창상성급성쌍측반구미만성뇌종창59례,전첨성연구환자입원시ICP、거골판감압환자술전ICP화술후ICP등림상자료,안상후6개월적GOS평분분위회복량호조(GOS4 ～5분)화회복불량조(GOS 1 ～3분).탐토입원시ICP、거골판감압환자술전ICP、술후ICP여예후적관계.결과 본조병례회복량호솔69％ (41/59),회복불량솔31％ (18/59),병사솔15％ (9/59).입원시GCS≥9분적환자예후무사망급식물생존,입원시GCS 13～14분적환자균회복공작혹학습(GOS5분).재지속유창ICP감측하29례시행료거골판감압술.입원시ICP、거골판감압환자술전ICP화술후ICP회복량호조분별시(22.2 ±7.9)mm Hg、(31.9±9.5)mm Hg화(12.3 ±2.9)mm Hg；회복불량조분별시(33.4±18.9) mm Hg、(43.7±14.6)mm Hg화(13.0±5.6) mm Hg.량조지표상대응비교,환자입원시ICP、거골판감압환자술전ICP차이유통계학의의(P＜0.05),거골판감압환자술후ICP차이무통계학의의(P＞0.05).결론 지속유창ICP감측대창상성급성쌍측반구미만성뇌종창적치료유중요적지도작용,차류환자적예후여입원시ICP、거골판감압환자술전ICP유관.
Objective To explore the guiding role of invasive intracranial pressure (ICP) monitoring in the treatment of posttraumatic acute bilateral hemispheric diffuse brain swelling,and to analyze the relationship between ICP and the prognosis.Methods A total of 59 patients with acute posttranmatic bilateral hemisphere diffuse brain swelling,treated under the monitoring of invasive intracranial pressure between Feb.2010 and Oct.2011,in our department were chosen for the study.ICP values at admission,before,and after decompressive craniectomy of all 59 patients were collected.The 59 patients were divided into a group of good recovery (GOS 4 ～ 5) and a group of bad recovery (GOS 1 ～ 3) based on the Glasgow outcome scale (COS) 6 months after craniocerebral trauma.The relationship between prognosis and ICP at admission,ICP before and after decompressive craniectomy was analyzed.Results The good recovery rate was 69％ (41/59) and the bad recovery rate was 31％ (18/59),while the death rate was 15％ (9/59).No mortality or plant survival occurred in patients whose GCS ≥ 9 at admission,and all patients,whose GCS were between 13 ～ 14,came back to work or study (GOS =5).Twenty-nine patients accepted decompressive cranieetomy under continuous invasive ICP monitoring; for those with good recoveries,ICP at admission,ICP before and after decompressive craniectomy were respectively (22.2 ± 7.9)mmHg,(31.9±9.5) mm Hg,and (123 ±2.9) mm Hg; for those with bad recoveries,these indexes were respectively (33.4 ±18.9) mm Hg,(43.7 ± 14.6) mm Hg,and (13.0 ±5.6)mm Hg.There were significant statistic differences between the two groups for the indexes of patients' ICP at admission and ICP before decompressive craniectomy (P＜ 0.05).However,there were no significant statistical differences of ICP after decompressive craniectomy (P＞ 0.05).Conclusion Continuous invasive ICP monitoring has an important role in guiding the treatments for patients of posttraumatic bilateral hemispheric acute diffuse brain swelling,whose prognosis were related to ICP at admission and ICP before decompressive craniectomy.