摘要
目的探讨有创颅内压监测下脑室外引流(EVD)在双额叶重度脑挫伤阶梯治疗中的临床应用价值。方法56例双额叶重度脑挫伤患者按照是否采用颅内压监测下EVD术分为监测组和对照组,每组各28例。监测组患者采用于颅内压监测下EVD和(或)双额去骨瓣并内减压术;对照组采用常规双额去骨瓣并内减压术治疗。术后观察统计两组患者迟发性血肿的发生率、脱水剂使用剂量、常见并发症;术后6个月时采用格拉斯哥预后量表(Glasgow outcome score,GOS)评分评判患者的预后。结果监测组患者行双额去骨瓣并内减压术的比率(11例,39.3%)明显低于对照组(100%)(P<0.001)。监测组患者中无术后发生对侧硬膜外血肿和术区新发脑内血肿者,而对照组分别为7例和3例(P=0.01,P=0.236)。监测组患者使用甘露醇的剂量为(765.00±122.59)g,明显低于对照组的(1600±130.20)g(P<0.001)。监测组患者术后急性肾功能损害的发生率(1例,3.6%)明显低于对照组(10例,35.7%)。两组患者术后肺部感染、上消化道溃疡、尿路感染的发生率相比,差异均无统计学意义(均P>0.05)。术后6个月,监测组患者的预后良好率(92.59%)明显高于对照组(60.71%)(P=0.01)。结论及时采用有创颅内压监测下EVD治疗,可有效减少双额叶重度脑挫伤患者行双额去骨瓣并内减压术的病例,改善患者的预后,值得临床推广应用。
Objective To investigate the clinical value of extraventricular drainage(EVD)under invasive intracranial pressure monitoring in the treatment of severe bilateral frontal contusion.Methods 56 patients with severe brain contusion in bilateral frontal lobes were divided into monitoring group and control group according to whether EVD was performed under intracranial pressure monitoring,28 cases in each group.Patients in the monitoring group were treated with EVD and/or bilateral frontal decompressive craniectomy under intracranial pressure monitoring.The control group was treated with conventional double frontal osteotomy and internal decompression.The incidence of delayed hematoma,dosage of dehydrating agent and common complications were observed.Glasgow outcome score(GOS)was used to evaluate the prognosis 6 months after operation.Results The rate of double frontal osteotomy and internal decompression in the monitoring group(11 cases,39.3%)was significantly lower than that of the control group(100%)(P<0.001).No contralateral epidural hematoma and new intracerebral hematoma occurred in the monitoring group,while 7 cases and 3 cases in the control group(P=0.01,P=0.236).The dose of mannitol in the monitoring group was(765.00±122.59)g,significantly lower than that of the control group(1600±130.20)g(P<0.001).The incidence of acute renal function damage in the monitoring group(1 case,3.6%)was significantly lower than that of the control group(10 cases,35.7%).There was no significant difference in the incidence of pulmonary infection,upper gastrointestinal ulcer and urinary tract infection between the two groups(P>0.05).The prognosis of the patients in the monitoring group was significantly higher than that of the control group(60.71%)(P=0.01).Conclusion Timely use of EVD under invasive intracranial pressure monitoring can effectively reduce the cases of double frontal lobectomy and internal decompression in patients with severe brain contusion,and improve the prognosis of patients,which is worthy of clinical application.
作者
魏民
张远明
邢鸣
柴伟
何洪泉
高玉华
WEI Min;ZHANG Yuan-ming;XING Ming(Department of Neurosurgery,Gaochun People’s Hospital,Nanjing 211300,China)
出处
《临床神经外科杂志》
2021年第3期343-346,共4页
Journal of Clinical Neurosurgery
基金
江苏大学2018年临床医学科技发展基金(JLY20180223)。
关键词
有创颅内压监测
脑室外引流
双额叶脑挫伤
invasive intracranial pressure monitoring
extraventricular drainage
bilateral frontal lobe contusion
