摘要
目的研究影像学CT环池分级结合持续颅内压监测在重型颅脑损伤患者手术前后的临床应用价值。方法对25例重型颅脑损伤患者行开颅术,并予持续颅内压监测,记录颅内压值(ICP)。观察手术前后头颅CT环池分级,Ⅰ级:环池完全闭塞;Ⅱ级:0.1~1.0 mm;Ⅲ级:1.1~2.0 mm;Ⅳ级:>2.0 mm。并在术后6个月进行格拉斯哥预后量表(GOS)评分,GOS评分5~4分者为预后良好组,GOS评分3~1分者为预后不良组。分析环池分级、ICP及GOS评分之间的关系。结果重型颅脑损伤患者术前环池分级与预后无相关性,其开颅术后环池分级与ICPct存在负相关性,环池分级越低者的ICPct越高,差异有统计学意义。环池分级、ICP与预后存在相关性,开颅术后ICP72 h水平与患者GOS评分的相关性最强。预后不良组的ICP72 h值明显高于预后良好组,差异有统计学意义。受试者工作曲线显示:ICP72 h预测重型颅脑损伤预后的最佳临界点为21 mmHg,具有很强的预测价值。结论重型颅脑损伤开颅术患者的CT环池分级可反映其ICP水平,评估预后;ICP监测的作用优于环池分级,术后ICP72 h是较好的预后预测指标。将CT环池分级结合持续颅内压监测用于重型颅脑损伤开颅术治疗中,可及时发现问题,指导治疗和评估预后,具有重要的临床应用价值。
Objective To research the value of cisterna ambiens classification of CT imaging and intraoperative continuous monitoring of intracranial pressure（ ICP） in patients with severe traumatic brain injury（ s TBI） before and after operation. Methods ICP monitoring and brain CT examination of twenty-five patients who underwent craniectomy after severe traumatic brain injury were performed. The ICP value and cisternal grades were recorded,and cisterna ambiens degree was classified as followings： Grade Ⅰ： The central pool of occlusion; Grade Ⅱ： 0. 1-1. 0 mm; Grade Ⅲ：1. 0-2. 0 mm; Grade Ⅳ： 2. 0 mm. Five point Glasgow outcome（ GOS） was used for outcome assessment after six months after operation. Outcome is further classified into favourable（ GOS scores4,5） and unfavourable（ GOS scores 3 to 1） for analysis. Then,statistical analyses were performed based on these factors（ cisternal grades,ICP and prognosis）. Results Cisternal grade was found to be not influencing the outcome of patients with severe traumatic brain injury before operation. Found a negative correlation between basal cisterns classification and ICP level after operation; and the lower the basal cisterns classification,the higher the ICP,The difference between different groups is statistically significant. Found a correlation between cisterna ambiens classifications,ICP level and prognosis. Strongest correlation was found between prognosis and ICP72 hafter operation. The ICP value of unfavourable prognosis group is much significantly higher than the ICP value of favourableprognosis group. Having found that ICP72 his a strong predictor outcome（ considering favourable outcome）. ROC curve was made for finding out the optimal cutoff（ ICP72 h= 21 mmHg） as a predictor. Conclusions Cisterna ambiens classification can reflect ICP level,and ICP72 his superior to cisterna ambiens classification for assessing prognosis of craniectomy patients with traumatic brain injury. Cisternal grade and continuous ICP in the treatment of preoperative and postoperative patients with sT BI contribute to identify problems timely and guide therapy and assess prognosis,and play an important clinical value treatment of sT BI patients.
作者
张艺滨
郑艺芳
李光海
陈良鑫
陈小燕
郑婉玲
ZHANG Yi-bin;ZHENG Yi-fang;LI Guang-hai(Department of Neurosurgery, Dehua County Hospital, Quanzhou 362500, Chin)
出处
《临床神经外科杂志》
CAS
2018年第2期128-133,共6页
Journal of Clinical Neurosurgery
基金
2014泉州卫生科研资助项目[(2014)267-34]
泉州科技计划项目(2015Z51)
关键词
重型颅脑损伤
神经外科手术
CT环池
颅内压
预后
severe traumatic brain injury
neurosurgical procedures
CT cisterna ambiens
intracranial pressure
prognosis
