颅内压监测在额叶挫裂伤患者中的应用
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摘要
目的:分析额叶脑挫裂伤患者处理措施对预后的影响,探讨不同类型颅内压(ICP)监测在额叶脑挫裂伤患者中的应用价值。方法:回顾性分析深圳市第二人民医院2010年1月至2017年12月收治的173例额叶脑挫裂伤患者〔格拉斯哥昏迷量表(GCS)评分9～15分〕,其中68例未使用ICP监测的患者为对照组;56例应用皮层型ICP监测的患者为皮层型组;49例应用脑室型ICP监测的患者为脑室型组。对照组使用经验性治疗控制ICP,皮层型组和脑室型组根据ICP水平进行相应的阶梯式降ICP治疗,脑室型组可通过释放脑脊液途径降低ICP。患者伤后随访1年,比较各组行开颅手术治疗率、1年后格拉斯哥预后量表(GOS)评分和颅脑创伤(TBI)相关并发症发生率。分析ICP监测在额叶脑挫裂伤患者的应用价值。结果:各组患者入院时的GCS评分比较,差异无统计学意义(P> 0.05),经过治疗后全部存活。与对照组比较,皮层型组和脑室型组1年后GOS评分有显著改善,开颅手术治疗率显著降低,差异具有统计学意义(P <0.001),而三组患者颅内感染、肺部感染、脑积水和硬膜下积液等并发症发生率比较,差异均无统计学意义(P> 0.05)。皮层型组和脑室型组1年后GOS比较,差异无统计学意义(P> 0.05),脑室型组的ICP维持正常水平时间比例和开颅手术治疗率优于皮层型组,差异具有统计学意义(P <0.01)。结论:额叶挫裂伤因临床症状不典型容易出现脑疝并引起严重后果,临床应用ICP监测有利于病情观察并指导治疗,改善患者预后。脑室型ICP监测可更有效控制颅内高压。
Objective To analyze the effect of treatment on the prognosis of patients with frontal contusions, and explore the application of different types of intracranial pressure monitoring in patients with frontal contusions. Methods A retrospective analysis was made on the records of 173 patients with frontal contusion in our hospital between January 2010 and December(GCS9-15). 56 cases using cortical ICP monitoring were assigned into cortical group; 49 cases using intraventricular ICP monitoring were assigned into ventricular group; 68 cases were assigned into control group and received experiental treatment to control ICP. The cortical group and ventricular group received a step-wise treatment according to the ICP level. Patients were followed up to 1 year after injury. Craniotomy treatment rate, GOS and incidence of complication were compared in each groups after 1 year. Results There was no significant difference in GCS scores between the groups at admission(P > 0.05), and all survived after treatment.Compared with the control group, the cortical group and the ventricle group had a significant improvement in GOS score after1 year, and the rate of craniotomy was significantly lower, and the difference was statistically significant(P < 0.001). There were no significant differences in the incidence of complications such as intracranial infection, pulmonary infection, hydrocephalus and subdural effusion in the three groups(P > 0.05). There was no significant difference in the GOS between the cortical group and the ventricle group after 1 year(P > 0.05). The ratio of ICP to normal level and the rate of craniotomy in the ventricle group were superior to those in the cortical group, and the difference was statistically significant(P < 0.01). Conclusions Forehead contusion and laceration is prone to cerebral palsy due to atypical clinical symptoms and cause serious consequences. Clinical application of ICP monitoring is conducive to the observation of the disease and guide treatment to improve the prognosis of patients.
Objective To analyze the effect of treatment on the prognosis of patients with frontal contusions, and explore the application of different types of intracranial pressure monitoring in patients with frontal contusions. Methods A retrospective analysis was made on the records of 173 patients with frontal contusion in our hospital between January 2010 and December(GCS9-15). 56 cases using cortical ICP monitoring were assigned into cortical group; 49 cases using intraventricular ICP monitoring were assigned into ventricular group; 68 cases were assigned into control group and received experiental treatment to control ICP. The cortical group and ventricular group received a step-wise treatment according to the ICP level. Patients were followed up to 1 year after injury. Craniotomy treatment rate, GOS and incidence of complication were compared in each groups after 1 year. Results There was no significant difference in GCS scores between the groups at admission(P > 0.05), and all survived after treatment.Compared with the control group, the cortical group and the ventricle group had a significant improvement in GOS score after1 year, and the rate of craniotomy was significantly lower, and the difference was statistically significant(P < 0.001). There were no significant differences in the incidence of complications such as intracranial infection, pulmonary infection, hydrocephalus and subdural effusion in the three groups(P > 0.05). There was no significant difference in the GOS between the cortical group and the ventricle group after 1 year(P > 0.05). The ratio of ICP to normal level and the rate of craniotomy in the ventricle group were superior to those in the cortical group, and the difference was statistically significant(P < 0.01). Conclusions Forehead contusion and laceration is prone to cerebral palsy due to atypical clinical symptoms and cause serious consequences. Clinical application of ICP monitoring is conducive to the observation of the disease and guide treatment to improve the prognosis of patients.
引文
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[2]Wang Z,Su N,Wu RL,et al.Decompressive craniectomy with bifrontal coronal incision in the management of frontotemporal contusion and laceration for early cranioplasty[J].J Craniofac Surg,2017,28(6):1442-1444.
[3]Peterson EC,Chesnut RM.Talk and die revisited:bifrontal contusions and late deterioration[J].J Trauma,2011,71(6):1588-1592.
[4]Rehman T,Ali R,Tawil I,et al.Rapid progression of traumatic bifrontal contusions to transtentorial herniation:Acase report[J].Cases J,2008,1(1):203.
[5]Jiang JY,Gao GY,Feng JF,et al.Traumatic brain injury in China[J].Lancet Neurol,2019,18(3):286-295.
[6]刘佰运.正确认识脑外伤大骨瓣开颅手术[J].中华创伤杂志,2012,28(8):673-675.
[7]Aarabi B,Hesdorffer DC,Ahn ES,et al.Outcome following decompressive craniectomy for malignant swelling due to severe head injury[J].J Neurosurg,2006,104(4):469-479.
[8]Bor-Seng-Shu E,de-Lima-Oliveira M,Nogueira RC,et al.Decompressive craniectomy for traumatic brain injury:postoperative TCD cerebral hemodynamic evaluation[J].Front Neurol,2019,12(10):354.
[9]Gao L,Wu X,Hu J,et al.Intensive management and prognosis of 127 cases with traumatic bilateral frontal contusions[J].World Neurosurg,2013,80(6):879-888.
[10]Fossi F,Robba C,Rota M,et al.Intracranial pressure monitor insertion in traumatic brain injury:a single center,retrospective decision process analysis[J].J Neurosurg Sci,2018,8.[Epub ahead of print]
[11]Roach J,Gaastra B,Bulters D,et al.Safety,accuracy,and cost effectiveness of bedside bolt external ventricular drains(EVDs)in comparison with tunneled EVDs inserted in theaters[J].World Neurosurg,2019,5(125):e473-e478.
[12]Norager NH,Lilja-Cyron A,Hansen TS,et al.Deciding on the appropriate telemetric intracranial pressure monitoring system[J].World Neurosurg,2019,18(126):564-569.