重型颅脑损伤患者术后头颅CT环池分级与无创颅内压及脑脊液乳酸的相关性分析

doi:10.3969/j.issn.1671-7171.2023.11.020

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摘要【目的】探讨重型颅脑损伤患者术后头颅CT环池分级与无创颅内压(NICP)及脑脊液乳酸的关系。【方法】选取2019年10月至2022年10月宝鸡市人民医院收治的128例重型颅脑损伤患者,依据患者头颅CT术前环池分级将其分为Ⅰ级组(n=61)、Ⅱ级组(n=46)、Ⅲ级组(n=21)。比较不同分级组患者的颅内压、脑脊液乳酸差异,并采用Spearman相关分析头颅CT环池分级与无创颅内压、脑脊液乳酸的相关性。【结果】术前不同CT环池分级患者术后4 h、术后72 h的CT环池分级情况比较,差异均有统计学意义(P<0.001);Ⅱ级组、Ⅲ级组患者术后4 h、术后72 h的CT环池分级呈下降趋势(均P<0.05)。术后4 h、术后72 h,不同环池分级患者的NICP均低于术前(P<0.05);术后4 h、术后72 h,Ⅱ级组、Ⅲ级组NICP均低于Ⅰ级组,Ⅲ级组低于Ⅱ级组(P<0.05)。术后4 h、术后72 h,不同环池分级患者的脑脊液乳酸水平均低于术前(P<0.05);术后4 h、术后72 h,Ⅱ级组、Ⅲ级组脑脊液乳酸水平均低于Ⅰ级组(P<0.05)。头颅CT环池分级与术后NICP均呈负相关(P<0.05);术前头颅CT环池分级与术前、术后72 h脑脊液乳酸水平均呈负相关(P<0.05);术后4 h环池分级仅与术后72 h脑脊液乳酸水平呈负相关(P<0.01);术后72 h环池分级与术前、术后72 h脑脊液乳酸水平呈负相关(P<0.01)。【结论】重型颅脑损伤患者术前评估CT环池分级能够反映术后NICP水平,且与术前脑脊液乳酸水平密切相关。

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	孙峻峰
	高强
	常蒲英

关键词 ：颅脑损伤/外科学, 体层摄影术,X线计算机, 颅内压, 乳酸/脑脊髓液

Abstract：【Objective】To explore the relationship between postoperative CT cistern grading,non-invasive intracranial pressure(NICP),and cerebrospinal fluid lactate in patients with severe head injury.【Methods】A total of 128 patients with severe traumatic brain injury admitted to Baoji People's Hospital from October 2019 to October 2022 were selected and divided into grade Ⅰ group(n=61),grade Ⅱ group(n=46),and grade Ⅲ group(n=21) based on the preoperative circumferential pool grading of the patient's head CT. We compared the differences in intracranial pressure and cerebrospinal fluid lactate levels among patients with different grades,and used Spearman correlation analysis to investigate the correlation between head CT ring pool grading and non-invasive intracranial pressure and cerebrospinal fluid lactate levels. 【Results】 There was a statistically significant difference in CT annulus grading between patients with different preoperative CT annulus grading at 4 hours and 72 hours after surgery(P<0.001); The CT annular pool grading of patients in the Class Ⅱ and Ⅲ groups showed a decreasing trend at 4 hours and 72 hours after surgery(both P<0.05). At 4 hours and 72 hours after surgery,the NICP of patients with different ring pool grades was lower than before surgery(P<0.05); At 4 hours and 72 hours after surgery,the NICP levels in the grade Ⅱ and Ⅲ groups were lower than those in the grade Ⅰ group,while the NICP levels in the grade Ⅲ group were lower than those in the grade Ⅱ group(P<0.05). At 4 hours and 72 hours after surgery,the cerebrospinal fluid lactate levels in patients with different cistern grading were lower than before surgery(P<0.05); At 4 hours and 72 hours after surgery,the cerebrospinal fluid lactate levels in the grade Ⅱ and Ⅲ groups were lower than those in the grade Ⅰ group(P<0.05). There was a negative correlation between the grading of the cranial CT annulus and postoperative NICP(P<0.05); There was a negative correlation between preoperative CT cistern grading and cerebrospinal fluid lactate levels both before and 72 hours after surgery(P<0.05); The grading of the cistern at 4 hours postoperatively was only negatively correlated with the lactate level in cerebrospinal fluid at 72 hours postoperatively(P<0.01); There was a negative correlation(P<0.01) between the 72 hours postoperative grading of the cistern and the preoperative and 72 hours postoperative cerebrospinal fluid lactate levels.【Conclusion】 Preoperative evaluation of CT cistern grading in patients with severe head injury can reflect postoperative NICP levels and is closely related to preoperative cerebrospinal fluid lactate levels.

Key words： Craniocerebral Trauma/SU Tomography, X-Ray Computed Intracranial Pressure Lactic Acid/CF

收稿日期: 2022-10-26

中图分类号:

R651.15

通讯作者: * E-mail:changpy2021@163.com

引用本文:

孙峻峰, 高强, 常蒲英. 重型颅脑损伤患者术后头颅CT环池分级与无创颅内压及脑脊液乳酸的相关性分析[J]. 医学临床研究, 2023, 40(11): 1683-1686.
SUN Junfeng, GAO Qiang, CHANG Puying. Analysis of the Correlation between Postoperative CT Cistern Grading and Non-invasive Intracranial Pressure and Cerebrospinal Fluid Lactate in Patients with Severe Traumatic Brain Injury. JOURNAL OF CLINICAL RESEARCH, 2023, 40(11): 1683-1686.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2023.11.020 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2023/V40/I11/1683

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