本文選題：重型顱腦損傷 + 顱內(nèi)高壓�。� 參考：《寧夏醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討顱內(nèi)壓監(jiān)測(cè)在重型顱腦損傷患者術(shù)后的臨床應(yīng)用效果,了解術(shù)后顱內(nèi)壓變化情況,指導(dǎo)顱腦損傷患者術(shù)后脫水藥物的使用。方法:搜集2014年9月~2016年9月期間寧夏醫(yī)科大學(xué)附屬心腦血管醫(yī)院重型顱腦損傷患者(GCS評(píng)分3~8分)23例作為研究對(duì)象,所有病人傷后24小時(shí)內(nèi)入院,給予顱腦CT檢查,均行單側(cè)標(biāo)準(zhǔn)去骨瓣減壓術(shù)。其中10例采用前瞻性研究,術(shù)后于額部骨窗旁硬膜下安放顱內(nèi)壓監(jiān)測(cè)探頭,另13例為同期重型顱腦損傷單側(cè)標(biāo)準(zhǔn)去骨瓣減壓術(shù)后未安放顱內(nèi)壓監(jiān)測(cè)探頭的病人。術(shù)后兩組給予抑酸、補(bǔ)液等常規(guī)處理的同時(shí),ICP監(jiān)測(cè)組記錄每小時(shí)顱內(nèi)壓數(shù)值,根據(jù)顱內(nèi)壓數(shù)值變化調(diào)整甘露醇用量,對(duì)照組按常規(guī)經(jīng)驗(yàn)給予甘露醇,觀察兩組術(shù)后七天甘露醇總的用量、腎功能、水電解質(zhì)紊亂情況以及術(shù)后七天監(jiān)測(cè)組顱內(nèi)壓變化等情況。結(jié)果:1、ICP監(jiān)測(cè)組甘露醇總用量為575.00±102.06g,對(duì)照組為815.38±163.47g,差異具有統(tǒng)計(jì)學(xué)意義(t=-4.319,P=0.000)。監(jiān)測(cè)組甘露醇總使用時(shí)間為22.80±9.93天,對(duì)照組為25.08±11.30天,使用天數(shù)無(wú)明顯差異(t=-0.504,P=0.619);2、ICP監(jiān)測(cè)組腎功能不全1例,水電解質(zhì)紊亂2例。對(duì)照組腎功能不全8例,水電解質(zhì)紊亂9例,差異有統(tǒng)計(jì)學(xué)意義;3、通過(guò)持續(xù)觀察監(jiān)測(cè)組術(shù)后7天ICP的變化情況,發(fā)現(xiàn)ICP有一定的變化規(guī)律。且可能通過(guò)ICP變化判斷患者病情是否進(jìn)展及預(yù)后。大部分患者在術(shù)后4小時(shí)內(nèi)ICP無(wú)明顯升高,12小時(shí)內(nèi)ICP升高至15~20 mm Hg左右,給予甘露醇脫水降顱壓效果顯著,ICP可有所下降或保持相對(duì)穩(wěn)定;術(shù)后48小時(shí)左右患者顱內(nèi)壓數(shù)值開始出現(xiàn)高峰,大部分病人ICP數(shù)值達(dá)最高峰出現(xiàn)在術(shù)后的第3~5天,ICP波動(dòng)在值在25~35mm Hg左右,有少部分病人ICP數(shù)值可達(dá)到35~40 mm Hg,給予脫水降顱壓治療后,ICP可有所下降并保持在相對(duì)穩(wěn)定狀態(tài),查看患者生命體征都相對(duì)平穩(wěn)。一般從第5天后開始逐漸回落。這些患者20天后的格拉斯哥預(yù)后評(píng)分2例良好,2例輕殘,5例重殘。1例患者在術(shù)后1~4小時(shí)即出現(xiàn)顱內(nèi)壓持續(xù)性升高,ICP值迅速增高至30~40 mm Hg,給予脫水降顱壓等對(duì)癥治療后無(wú)明顯改善,急查顱腦CT后發(fā)現(xiàn)手術(shù)部位再次出血,再次手術(shù)治療,術(shù)后此例患者顱內(nèi)壓變化情況同前9例患者,20天后格拉斯哥預(yù)后評(píng)分為植物狀態(tài)。4、術(shù)后20天格拉斯哥預(yù)后評(píng)分ICP監(jiān)測(cè)組10例患者中2例(20%)良好,2例(20%)輕殘,5例(50%)重殘,1例(10%)植物狀態(tài);對(duì)照組13例患者中2例(15%)良好,4例(31%)輕殘,6例(46%)重殘,1例(8%)植物狀態(tài)。從結(jié)果中我們可以看出對(duì)照組較監(jiān)測(cè)組輕殘患者多,但對(duì)比無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:1、根據(jù)ICP監(jiān)測(cè)的數(shù)據(jù),能夠有效的指導(dǎo)甘露醇的用量,同時(shí)降低了因脫水藥物帶來(lái)的急性腎功能不全、水電解質(zhì)紊亂等一系列并發(fā)癥的發(fā)病率,在一定程度上有助于患者的病情恢復(fù)。2、在重型顱腦損傷患者術(shù)后七天ICP具有一定的變化規(guī)律,一般于3~5天達(dá)到ICP高峰,通過(guò)ICP的高低及持續(xù)時(shí)間一定程度上可判斷患者的病情及預(yù)后。3、在術(shù)后ICP監(jiān)測(cè)可以有效地發(fā)現(xiàn)顱內(nèi)壓變化狀況,為需再次手術(shù)的患者贏取了寶貴的治療時(shí)間,可能對(duì)其預(yù)后產(chǎn)生良好的效果。
[Abstract]:Objective: To investigate the clinical effect of intracranial pressure monitoring in patients with severe craniocerebral injury after operation, to understand the changes of intracranial pressure after operation and to guide the use of dehydrating drugs after craniocerebral injury. Methods: 23 cases of severe craniocerebral injury (GCS score 3~8 score) in the affiliated cardio cerebral vascular Hospital of Ningxia Medical University in September 2014 and September were collected. As the study object, all patients were admitted to hospital within 24 hours after injury, and the CT examination was given to the craniocerebral, and the unilateral standard bone flap decompression was performed. 10 of them were prospectively studied, after the operation, the intracranial pressure monitoring probe was placed near the frontal bone window, and the other 13 cases were not monitored for intracranial pressure after the single side standard bone flap decompression for the same period of severe craniocerebral injury. The patients in the two groups were given the routine treatment of the two groups after the operation, such as acid suppression and rehydration, while the intracranial pressure values were recorded per hour, the mannitol was adjusted according to the changes in the intracranial pressure. The control group was given mannitol according to the routine experience. The total amount of mannitol in the two groups after seven days of operation, the renal function, the disorder of water and electrolyte and seven after operation were observed. Results: 1, the total amount of mannitol in the ICP monitoring group was 575 + 102.06g, the control group was 815.38 + 163.47g, and the difference was statistically significant (t=-4.319, P=0.000). The total use time of mannitol in the monitoring group was 22.80 + 9.93 days, the control group was 25.08 + 11.30 days, there was no significant difference (t=-0.504, P=0.619), 2, ICP. There were 1 cases of renal insufficiency in the monitoring group, 2 cases of water electrolyte disorder, 8 cases of renal insufficiency in the control group and 9 cases of water and electrolyte disorder, and the difference was statistically significant. 3, the changes of ICP in the 7 days after the operation of the monitoring group were observed continuously, and the change of ICP was found. And the prognosis of the patients was judged by ICP alteration. Most of the patients were diagnosed. There was no significant increase in ICP within 4 hours after operation, and ICP increased to 15~20 mm Hg in 12 hours. The effect of mannitol dehydration and reduction of cranial pressure was significant, and ICP decreased or remained relatively stable; the number of intracranial pressure in the patients began to peak at 48 hours after the operation, and the highest peak of ICP in most patients appeared on 3~5 days after operation and ICP fluctuation. At the value of 25~35mm Hg, a small number of patients had a ICP value of 35~40 mm Hg. After the dehydration and intracranial pressure treatment, ICP could be reduced and maintained in a relatively stable state. The patient's vital signs were relatively stable. Generally, the patients began to decline gradually from fifth days later. The prognosis of the patients in 20 days was good in 2 cases, and 2 cases were light. Residual intracranial pressure in 5 cases of severe disability.1 cases increased continuously at 1~4 hours after operation, ICP value increased rapidly to 30~40 mm Hg, and there was no obvious improvement after treatment with dehydration and craniocerebral pressure and other symptomatic treatment. After acute craniocerebral CT, the surgical site was re bleeding and reoperated, and the changes of intracranial pressure in this case were similar to those of the first 9 cases, 20 days later. The lasto prognosis score was plant state.4, 20 days after the operation, 2 cases (20%) were good, 2 cases (20%), 5 (50%) heavy disability, 1 (10%) plant state, and 1 cases (10%) in the ICP monitoring group, and 2 cases (10%) in the control group, and 2 cases (15%) in 13 cases in the control group. Compared with the monitoring group, there are many light disability patients, but there is no statistical significance. Conclusion: 1, according to the data of ICP monitoring, it can effectively guide the dosage of mannitol, and reduce the incidence of a series of complications, such as acute renal insufficiency caused by dehydrating drugs, water electrolyte disorder and so on, to some extent help the patient to recover.2, In patients with severe craniocerebral injury, ICP has a certain change rule on the seven day after operation, which generally reaches the peak of ICP on 3~5 days. The patient's condition and prognosis can be judged by the height and duration of ICP to a certain degree.3. The changes of intracranial pressure can be found effectively after the operation of ICP, and valuable treatment for the patients who need to be reoperated again. Time may have a good effect on its prognosis.

【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.15

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