论文部分内容阅读
目的:探讨颅内压(intracranial pressure,ICP)监护下行腰大池置管引流在重型颅脑损伤开颅去骨瓣减压术后的治疗效果。方法:123例重型颅脑损伤开颅血肿清除去骨瓣减压术患者随机分为2组,其中73例患者在颅内压监护下行腰大池引流作为治疗组,50例患者只行腰大池引流作为对照组,通过观察2组患者甘露醇使用量、脑脊液引流量、并发症的发生率及6个月格拉斯哥预后评分(Glasgow outcome score,GOS)进行比较。结果:治疗组甘露醇使用量[(428.01±111.85)g]和使用时间[(4.52±1.54)d],对照组甘露醇使用量[(794.00±179.32)g]和使用时间为[(8.36±2.06)d]相比较差异有统计学意义(t=13.940,P=0.000;t=11.840,P=0.000)。治疗组脑脊液引流量为(1 180.40±174.63)m L,对照组脑脊液引流量为(1 663.58±213.61)m L,差异有统计学意义(t=13.750,P=0.000)。治疗组主要并发症(脑疝、二次出血、电解质紊乱、急性肾损伤)的发生率均低于对照组,差异有统计学意义(P<0.05)。治疗组格拉斯哥预后评分恢复较好(恢复良好+轻度残疾)比率为63%,对照组恢复较好比率为44%,2组比较差异有统计学意义(χ~2=4.340,P=0.040)。结论:颅内压监护下行腰大池引流脑脊液在重型颅脑损伤去骨瓣减压术后的治疗效果优于单纯行腰大池持续引流。
Objective: To investigate the curative effect of intracranial pressure (ICP) monitoring of descending lumbar cistern drainage in the treatment of severe craniocerebral injury with craniotomy. Methods: One hundred and thirty-three patients with craniocerebral injury who underwent craniotomy hematoma removal and decompression of bone flap were randomly divided into 2 groups. Among them, 73 patients underwent drainage of the lumbar cistern as the treatment group under the care of intracranial pressure and 50 patients underwent drainage of the lumbar cistern As a control group, mannitol consumption, cerebrospinal fluid drainage, incidence of complications and Glasgow outcome score (GOS) of 6 months were compared between two groups. Results: The mannitol consumption in the treatment group [(428.01 ± 111.85) g] and the duration of use [(4.52 ± 1.54) d] and the mannitol consumption in the control group [(794.00 ± 179.32) g] 2.06) d] (t = 13.940, P = 0.000; t = 11.840, P = 0.000). The drainage volume of cerebrospinal fluid in the treatment group was (180.40 ± 174.63) m L, while that in the control group was (663.58 ± 213.61) m L, the difference was statistically significant (t = 13.750, P = 0.000). The incidence of major complications (hernia, secondary bleeding, electrolyte imbalance, acute kidney injury) in the treatment group was lower than that in the control group (P <0.05). The Glasgow prognostic score of the treatment group recovered better (recovery + mild disability) was 63%, while that of the control group was 44%, the difference was statistically significant (χ ~ 2 = 4.340, P = 0.040) . Conclusion: The effect of intracranial pressure monitoring lumbar cistern drainage of cerebrospinal fluid in the treatment of severe traumatic brain injury after decompressive craniectomy is superior to simple continuous drainage of the lumbar cistern.