Abstract:【Objective】To explore the value of invasive Intracranial pressure monitoring in decompressive craniectomy for severe traumatic brain injury (sTBI). 【Methods】A total of 78 sTBI patients who underwent decompressive craniectomy in our hospital from July 2018 to July 2021 were selected and randomly divided into an observation group and a control group, with 39 patients in each group. The control group received decompressive craniectomy, and the observation group used invasive Intracranial pressure monitoring while decompressive craniectomy. The clinical efficacy and postoperative complications of the two groups were compared, including the length of stay in the NICU, the amount of Mannitol, the use time of Mannitol, Intracranial pressure at different time points before and after surgery, and biochemical indicators before and after surgery [interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α(TNF-α), neuron specific Enolase (NSE)].【Results】The good prognosis rate of the observation group was significantly higher than that of the control group, and the difference was statistically significant (P<0.05). The NICU hospitalization time, Mannitol dosage and Mannitol use time in the observation group were significantly shorter than those in the control group (P<0.05). The intracranial pressure of patients in the two groups was lower than that before operation on the 1st, 3rd and 7th days after operation, with a statistically significant difference (P<0.05); The intracranial pressure of the observation group was lower than that of the control group 3 days and 7 days after operation, with a statistically significant difference (P<0.05). After surgery, two groups of serum IL-6, hs-CRP, TNF-α,the NSE level was lower than those before surgery, and the observation group was lower than the control group, with a statistically significant difference (P<0.05). The total incidence of postoperative complications in the observation group was lower than that in the control group, and the difference was statistically significant (P<0.05). 【Conclusions】 The use of invasive Intracranial pressure monitoring in decompressive craniectomy for sTBI patients can effectively shorten the hospital stay of NICU, reduce the dosage of Mannitol, restore Intracranial pressure, and significantly improve the neurological function and prognosis of patients.
赵振义, 闵小彬, 樊学海, 郭志刚. 有创颅内压监测用于重型颅脑创伤去骨瓣减压术中的价值[J]. 医学临床研究, 2023, 40(7): 1047-1049.
ZHAO Zhen-yi, MIN Xiao-bin, FAN Xue-hai, et al. The Value of Invasive Intracranial Pressure Monitoring in Decompressive Craniectomy for Severe Traumatic Brain Injury. JOURNAL OF CLINICAL RESEARCH, 2023, 40(7): 1047-1049.
[1] GOMEZ A,BATSON C,FROESE L, et al. The utility of transcranial doppler in moderate and severe traumatic brain injury:A narrative review of cerebral physiologic metrics[J].J Neurotrauma,2021,38(16):2206-2220. [2] SHANKAR J,GREEN R,VIRANI K, et al. Admission perfusion CT for classifying early in-hospital mortality of patients with severe traumatic brain injury:a pilot study[J].Am J Roentgenol,2020, 214(4):1-5. [3] HUANG T H,CHEN C Z,KUO H I, et al. Enhanced risk of traumatic brain injury in patients with chronic obstructive pulmonary disease[J].J Investig Med,2019, 68(4):19-27. [4] 秦梦阳, 张文泰, 凌宇辉,等. 重型颅脑创伤和重症高血压脑出血患者有创颅内压监测术后早期颅内感染及其危险因素[J].中国医科大学学报, 2019, 48(9):786-790. [5] 中华神经外科学会神经创伤专业组. 颅脑创伤去骨瓣减压术中国专家共识[J].中华神经外科杂志,2013,29(9):967-969. [6] 韩志桐,张瑞剑,陈云照,等. 颅内压联合脑血流监测在重度颅脑损伤患者标准去骨瓣减压术后的应用效果[J].中国医药导报,2018,15(23):52-55. [7] PAN Y, XUE Y, ZHAO P, et al. Significance of ICP-related parameters for the treatment and outcome of severe traumatic brain injury[J].J Int Med Res,2020, 48(8):129-130. [8] 杨平来, 余前, 丁俊宏,等. 颅脑外伤开颅术后颅内压监测患者发生术后感染的影响因素[J].神经损伤与功能重建, 2019, 14(7):369-370. [9] 程科, 方宪清, 程彪,等. 有创动态颅内压监测在重度颅脑损伤治疗中的应用效果观察[J].山西医药杂志, 2019, 48(4):471-474. [10] 李克. 超声测量视神经鞘直径在诊断去骨瓣减压术后患者颅内压增高中的价值[J].医学综述, 2020, 26(1):153-158. [11] 刘来兴, 邓轶鑫, 刘福泉,等. 颅脑创伤患者的颅内压相关参数与预后的相关性研究[J].中国医学装备, 2019, 16(10):85-88. [12] 马廉亭. 颅脑损伤去骨瓣减压术后是否实施有创颅内压监测的商榷[J].中国临床神经外科杂志, 2020, 25(2):65-66.