目的 探讨颅内压监测联合脑室外引流在双侧额叶脑挫裂伤患者去骨瓣减压术后治疗的价值。方法 对2012-01至2023-12在武警江西总队医院接受双额去骨瓣减压术治疗的42例患者的临床资料进行总结,依据是否行颅内压监测,将患者分为监测组（n=21）和对照组（n=21）。对不同时间点的颅内压变化、甘露醇使用情况、恢复情况、并发症进行比较。结果 监测组和对照组患者术后48 h内颅内压[（35.25±3.30）mmHg vs.（35.33±2.52）mmHg],差异无统计学意义（P>0.05）;监测组术后72 h、96 h颅内压[（27.50±4.04）mmHg,（21.00±3.16）mmHg]明显低于对照组[（32.00±3.61）mmHg,（29.00±4.58）mmHg]（P<0.05）;监测组术后甘露醇使用量、使用时间[（1498.57±442.13）ml;（12.86±4.16）d]明显少于对照组[（3362.14±417.79）ml,（26.76±4.60）d]（P<0.05）;监测组并发症脑疝发生率明显低于对照组（4.76% vs. 28.57%;P<0.05）;术后6个月,监测组恢复良好比例明显高于对照组（P<0.05）。结论 颅内压监测联合脑室外引流能减少甘露醇用量及使用时间,降低并发症发生率,改善预后。
Abstract
Objective To explore the application of intracranial pressure （ICP） monitoring combined with external ventricular drainage （EVD） in the treatment of patients with bilateral frontal cerebral contusion after decompressive craniectomy. Methods The clinical data of 42 patients who underwent bilateral decompressive craniectomy treatment at Jiangxi Provincial Corps Hospital of Chinese People’s Armed Police Force from January 2012 to December 2023 were summarized. Based on whether they received ICP monitoring during the operation,the patients were divided into a detection group （n=21） and a control group （n=21）. The changes in intracranial pressure at different time points, the use of mannitol, recovery status, and complications were compared. Results The intracranial pressure within 48 hours after operation in the detection group and the control group were [（35.25±3.30）mmHg vs. （35.33±2.52）mmHg], respectively, and there was no significant difference in the above changes （P>0.05）. The intracranial pressures at 72 h and 96 h after operation in the detection group [（27.50±4.04） mmHg and （21.00±3.16） mmHg）] were significantly lower than that in the control group [（32.00±3.61）mmHg,（29.00±4.58）mmHg]（P<0.05）. The dosage and duration of postoperative mannitol in the detection group [（1498.57±442.13）ml; （12.86±4.16）d）] were significantly less than those in the control group [（3362.14±417.79）ml,（26.76±4.60）d]（P<0.05）. The incidence of cerebral hernia in the detection group was significantly lower than that in the control group （4.76% vs. 28.57%; P<0.05）.At six months after operation,the proportion of good recovery in the detection group was significantly higher than that in control group （P < 0.05）. Conclusions ICP monitoring combined with EVD can reduce the consumption and duration of mannitol, decrease the rate of complication, and improve the prognosis of patients.
关键词
双侧额叶脑挫裂伤 /
去骨瓣减压术 /
颅内压监测 /
脑室外引流
Key words
bilateral frontal cerebral contusion /
decompressive craniectomy /
intracranial pressure monitoring /
external ventricular drainage
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