重型颅脑损伤持续颅内压及脑灌注压监护的临床研究

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摘要目的探讨重型颅脑损伤持续颅内压（ICP）及脑灌注压（CPP）监护的临床效果，为临床提供指导。方法选择信封随机法抽取2015年10月~2016年12月我院伤后72 h内首诊入院的80例重型颅脑损伤患者作为研究对象，对80例重型颅脑损伤患者进行随机对照分组。对照组40例患者未应用监护，实验组40例患者应用持续ICP 及CPP监护，其中伤后＜24 h入院16例，伤后24~72 h入院24例，以入院时的CPP值将其分为甲组（CPP≥9.33 kPa）和乙组（CPP＜9.33 kPa），比较ICP及CPP监护的临床效果。结果实验组患者的恢复良好率为62.50%，显著高于对照组（40.00%），重度残疾率（5.00%）显著低于对照组（20.00%），病死率（7.50%）显著低于对照组（25.00%），实验组疗效优于对照组，差异有统计学意义（P＜0.05）。伤后＜24 h甲组患者的MABP、PaO2显著高于乙组（P＜0.05），其余指标差异无统计学意义（P＞0.05）；伤后24~72 h甲组患者的ICP显著低于乙组（P＜0.05），其余指标差异无统计学意义（P＞0.05）。结论对重型颅脑损伤患者实施持续ICP及CPP监护有助于改善患者预后，同时，临床应结合患者的实际情况对其实施合理的干预措施。

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	林立超
	杨建雄
	叶志其
	黄建斌
	张剑伟

关键词 ：重型颅脑损伤, 颅内压, 脑灌注压, 监护

Abstract：Objective To investigate the clinical effect of continuous intracranial pressure (ICP)and cerebral perfusion pressure (CPP)monitoring in patients with severe craniocerebral injury,and to provide guidance for clinical practice. Methods 80 patients with severe craniocerebral injury admited to hospital within 72 h after injury were selected as study object by random envelope extraction in our hospital from October 2015 to December 2016,they were randomly divided into control group and experimental group,40 cases in each group.Patients in the control group were not given monitoring,patients in the experimental group were given continuous ICP and CPP monitoring,in which 16 cases were admitted within 24 h after injury,24 cases were admitted within 24-72 h after injury,and patients in the experimental group were divided into group A (CPP≥9.33 kPa)and group B (CPP<9.33 kPa)according to CPP level of the admission,the clinical effects of ICP and CPP monitoring were compared.Results The good recovery rate of patients in the experimental group was 62.50%,significantly higher than that in the control group (40.00%),severe disability rate (5.00%)was significantly lower than that in the control group(20.00%),the mortality rate(7.50%)was significantly lower than that in the control group(25.00%),the clinical effect of the experimental group was better than that of the control group, and the difference was statistically significant(P<0.05).Within 24 h after injury,MABP,PaO2in group A was significantly higher than that in group B (P<0.05),there was no obvious difference in other indexes(P>0.05);within 24-72 h after injury,ICP in group A was significantly lower than that in group B(P<0.05),there was no obvious difference in other indexes(P>0.05).Conclusion The implementation of continuous ICP and CPP monitoring is helpful to improve the prognosis of patients with severe craniocerebral injury,at the same time reasonable intervention measures should be implemented combined with the actual situation of patients.

Key words： Severe craniocerebral injury Intracranial pressure Cerebral perfusion pressure Monitoring

引用本文:

林立超,杨建雄,叶志其,黄建斌,张剑伟. 重型颅脑损伤持续颅内压及脑灌注压监护的临床研究[J]. 中国当代医药, 2017, 24(9): 43-45.
LIN Li-chao;YANG Jian-xiong;YE Zhi-qi;HUANG Jian-bin;ZHANG Jian-wei. Clinical study of continuous intracranial pressure and cerebral perfusion pressure monitoring in patients with severe craniocerebral injury. 中国当代医药, 2017, 24(9): 43-45.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2017/V24/I9/43

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