本文關(guān)鍵詞： 顱內(nèi)壓監(jiān)護(hù) 腰大池引流 重型顱腦損傷 去骨瓣減壓術(shù)　出處：《重慶醫(yī)科大學(xué)學(xué)報》2017年10期 　論文類型：期刊論文

【摘要】：目的:探討顱內(nèi)壓(intracranial pressure,ICP)監(jiān)護(hù)下行腰大池置管引流在重型顱腦損傷開顱去骨瓣減壓術(shù)后的治療效果。方法:123例重型顱腦損傷開顱血腫清除去骨瓣減壓術(shù)患者隨機(jī)分為2組,其中73例患者在顱內(nèi)壓監(jiān)護(hù)下行腰大池引流作為治療組,50例患者只行腰大池引流作為對照組,通過觀察2組患者甘露醇使用量、腦脊液引流量、并發(fā)癥的發(fā)生率及6個月格拉斯哥預(yù)后評分(Glasgow outcome score,GOS)進(jìn)行比較。結(jié)果:治療組甘露醇使用量[(428.01±111.85)g]和使用時間[(4.52±1.54)d],對照組甘露醇使用量[(794.00±179.32)g]和使用時間為[(8.36±2.06)d]相比較差異有統(tǒng)計學(xué)意義(t=13.940,P=0.000;t=11.840,P=0.000)。治療組腦脊液引流量為(1 180.40±174.63)m L,對照組腦脊液引流量為(1 663.58±213.61)m L,差異有統(tǒng)計學(xué)意義(t=13.750,P=0.000)。治療組主要并發(fā)癥(腦疝、二次出血、電解質(zhì)紊亂、急性腎損傷)的發(fā)生率均低于對照組,差異有統(tǒng)計學(xué)意義(P0.05)。治療組格拉斯哥預(yù)后評分恢復(fù)較好(恢復(fù)良好+輕度殘疾)比率為63%,對照組恢復(fù)較好比率為44%,2組比較差異有統(tǒng)計學(xué)意義(χ~2=4.340,P=0.040)。結(jié)論:顱內(nèi)壓監(jiān)護(hù)下行腰大池引流腦脊液在重型顱腦損傷去骨瓣減壓術(shù)后的治療效果優(yōu)于單純行腰大池持續(xù)引流。
[Abstract]:Objective: to investigate the effect of lumbar cistern drainage under intracranial pressure monitoring in patients with severe craniocerebral injury after craniotomy and craniotomy. Methods: one hundred and three patients with severe craniocerebral injury were randomly divided into two groups: one hundred and twenty-three patients with craniotomy and hematoma clearance and decompression. Among them, 73 patients were treated with lumbar cistern drainage under intracranial pressure monitoring as treatment group, 50 patients were treated with lumbar cistern drainage as control group, and the amount of mannitol and cerebrospinal fluid drainage were observed in two groups. The incidence of complications and the Glasgow outcome score were compared. Results: the mannitol usage and duration in the treatment group [428.01 鹵111.85 g] and the control group [794.00 鹵179.32 g] and the time of use [8.36 鹵2.06 days] were compared. The cerebrospinal fluid drainage volume in the treatment group was 1 180.40 鹵174.63 mL, and that in the control group was 1 663.58 鹵213.61 mL. the difference was statistically significant. The main complications in the treatment group were cerebral hernia. The incidence of secondary bleeding, electrolyte disturbance and acute renal injury were lower than those in the control group. The difference was statistically significant (P 0.05). The recovery rate of Glasgow prognosis score in the treatment group was better than that of the control group (the recovery rate was better than that of the control group and the control group was 44%). Conclusion: intracranial pressure monitoring is a significant difference between the two groups (蠂 ~ 2, P = 24. 340, P = 0.040). The effect of cerebrospinal fluid drainage by lumbar cistern drainage in severe craniocerebral injury after decompression of bone flap was better than that of continuous lumbar cistern drainage alone.
【作者單位】： 石家莊市第三醫(yī)院神經(jīng)外科;
【分類號】：R651.15

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