CAJ | 학술논문

目的：探讨无创颅内压监测与阶梯式治疗方案在颅脑损伤治疗中的价值。方法前瞻性分析2013年10月至2014年8月我院收治72例颅脑损伤患者，随机分为对照组与监测组，每组各36例。对照组应用传统的观察及治疗方法；监测组根据 GCS 评分分别进行有创（GCS≤8）、无创（GCS >8）颅内压监测，根据颅内压、患者生命体征、GCS 变化指导采取个体化阶梯式治疗方案控制颅内压并观察各组患者甘露醇用量、开颅手术治疗例数、ICU住院天数、6月后 GOS 评分评价疗效。结果监测组甘露醇用量、开颅手术例数较对照组明显减少（P <0.01）。重症 TBI 患者平均 ICU 住院天数监测组较对照组明显缩短。GOS 评分监测组明显优于对照组（P <0.01）。结论对颅脑外伤患者无论在有创、无创 ICP 监测指导下调整阶梯式个性化治疗措施，均能减少甘露醇用量，缩短 ICU 住院天数，提高患者预后，应该在临床大力推广。
목적：탐토무창로내압감측여계제식치료방안재로뇌손상치료중적개치。방법전첨성분석2013년10월지2014년8월아원수치72례로뇌손상환자，수궤분위대조조여감측조，매조각36례。대조조응용전통적관찰급치료방법；감측조근거 GCS 평분분별진행유창（GCS≤8）、무창（GCS >8）로내압감측，근거로내압、환자생명체정、GCS 변화지도채취개체화계제식치료방안공제로내압병관찰각조환자감로순용량、개로수술치료례수、ICU주원천수、6월후 GOS 평분평개료효。결과감측조감로순용량、개로수술례수교대조조명현감소（P <0.01）。중증 TBI 환자평균 ICU 주원천수감측조교대조조명현축단。GOS 평분감측조명현우우대조조（P <0.01）。결론대로뇌외상환자무론재유창、무창 ICP 감측지도하조정계제식개성화치료조시，균능감소감로순용량，축단 ICU 주원천수，제고환자예후，응해재림상대력추엄。
Objective:To explore the values of invasive,non-invasive intracranial pressure(ICP)monitoring in step-wise therapy of traumatic brain injury(TBI). Medthods:Seventy-two patients with TBI were randomly divided into ICP mo-nitoring group and conventional therapy group( control group)admitted at Department of Neurosurgery,Laiwu People′s Hospital Affiliated to Taishan Medical University from Oct. 2013 to Aug. 2014 and were evaluated prosepectively. The con-trol group had traditional observation and treatment. Monitoring group was divided into two groups of invasive(GCS≤8) and noninvasive(GCS > 8)ICP monitoring according to GCS score. ICP,vital signs and GCS score changes of patient were used to guide individualized and stepwise treatment. Control of intracranial pressure change,GOS score and mannitol dos-age were observed to evaluate the effect of the treatment. Results:Compared with the traditional group,the dose of manni-tol monitoring group significantly reduced(P < 0. 01). At follow-up of 6 months,GOS score of ICP monitoring group was significantly better than that of the control group(P < 0. 01). Conclusion:ICP monitoring significantly reduces the doseage and duration of mannitol therapy,for TBI TBI patients ICP should be monitored as early as possible. ICP monitoring can help the finding changes of patients′ condition timely,guidance and adjustment of individualized and stepwise treatment in time. It can aslo improve prognosis,and therefore is worthy of clinical application.