摘要
目的研究颅脑损伤病人颅内压变化对预后的影响。方法回顾性分析48例颅脑损伤病人的临床资料,均植入颅内压探头持续监测颅内压,每60 min记录1次,持续5 d。术后30 d行短期疗效评估,GCS变化≥1分者纳入改善组,余纳入恶化组。术后3个月行长期疗效评估,GOS 4~5分纳入预后良好组,GOS 1~3分纳入预后不良组。对相关数据进行统计学分析。结果术前GCS评分、挫伤或血肿体积、初始颅内压值及颅内压变化(ICP-P1、ICP-P2)在短期疗效评估的改善组与恶化组间存在显著差异(P<0.05),在长期疗效评估的预后良好组与预后不良组间也存在显著差异(P<0.05)。Logistic回归分析显示:颅内压变化幅度每增加1 mmHg不良预后危险因素成倍增加,且在短期疗效评估中影响更为明显。ROC曲线分析显示:初始颅内压值=31.50 mmHg,ICP-P1=4.29 mmHg,ICP-P2=3.97 mmHg是颅脑损伤病人短期疗效评估不良预后的临界值。初始颅内压值=28.00 mmHg,ICP-P1=3.21 mmHg,ICP-P2=2.93mmHg是长期疗效评估不良预后的临界值。结论保持颅脑损伤病人颅内压相对平稳有利于改善预后。
Objective To research the effect of intracranial pressure （ICP） changes on prognosis of patients with cerebral injury. Methods Clinical data of 48 patients with cerebral injury were analyzed retrospectively. The patients were planted with an ICP monitor, and the intracranial pressure value was recorded every 60 minutes and continuously recorded for 5 days. Short-term outcome was evaluated 30 days after the operation. The patients with GCS change greater than or equal to 1 score were involved in the improvement group, and the other patients were involved in the deterioration group. Long-term outcome was evaluated 3 months after the operation. The patients with GOS 4 to 5 scores were involved in the good prognosis group, and those with GOS 1 to 3 scores were involved in the poor prognosis group. Then, the statistical analysis was performed for these factors. Results There were significant differences in the preoperative GCS score, contusion or hematoma volume, the initial value of ICP and ICP changes （ICP-P1 and ICP-P2） between the improvement group and deterioration group in short-term outcome （P 〈 0.05）, and the same to the long-term outcome （P 〈 0.05）. The risk factors influcencing poor prognosis were multiplied with intracranial pressure amplitude increased 1 mmHg in a multivariable Logistic regression model, and the effect was more obviously reflected in the short-term outcome. Otherwise, the receiver operating characteristic （ROC） curve analysis showed that the critical values of poor prognosis in the short-term outcome were as follows： the initial value of ICP equal to 31.50 mmHg, ICP-P1 equal to 4.29 mmHg and ICP-P2 equal to 3.97 mmHg, while the critical values of poor prognosis in the long-term outcome were equal to 28.00 mmHg, 3.21 mmHg, 2.93 mmHg respectively. Conclusion Maintaining the ICP at an appropriate level is beneficial to improve the prognosis in cerebral injury patients.
作者
李鑫
王凡
刘少波
谢志敏
谷万春
Li Xin Wang Fan Liu Shaobo Xie Zhimin Gu Wanchun(Department of Neurosurgery No. 2, the Second People＇s Hospital of Htman Province, Changsha, Htman 410015, China)
出处
《中国微侵袭神经外科杂志》
CAS
2017年第6期245-248,共4页
Chinese Journal of Minimally Invasive Neurosurgery
基金
湖南省卫计委科研课题计划项目(编号:C2015-45)
湖南省临床重点专科建设项目(编号:2015-43)
关键词
颅脑损伤
颅内压
监测
预后
craniocerebral trauma
intracranial pressure
monitoring
prognosis
