本文選題：顱內(nèi)壓監(jiān)測(cè) + 顱腦損傷　； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景:顱腦損傷(traumatic brain injury,TBI)是指因外界暴力直接或間接地作用到頭部而引起的包括頭皮、顱骨和腦實(shí)質(zhì)在內(nèi)的各種頭顱組織損傷,其發(fā)生率居各型創(chuàng)傷首位。顱內(nèi)壓增高作為TBI最常見(jiàn)的并發(fā)癥,是反映患者病情嚴(yán)重程度的重要指標(biāo),尤其是中重度急性顱腦損傷中因出血、水腫等繼發(fā)性腦損傷所引起的急性ICP增高,是顱腦創(chuàng)傷中最嚴(yán)重的一種,是造成患者病情急劇惡化、預(yù)后不佳以及致死致殘的主要原因。因此,在診治TBI患者過(guò)程中,ICP的變化一直是神經(jīng)外科醫(yī)生的關(guān)注重點(diǎn)。自1960年Lundberg等人開始將ICP監(jiān)測(cè)應(yīng)用于實(shí)際診治當(dāng)中【1】,至今已有半個(gè)多世紀(jì)的歷程,其應(yīng)用越來(lái)越廣泛。目前,盡管ICP監(jiān)測(cè)已經(jīng)被國(guó)內(nèi)外學(xué)者廣泛認(rèn)可并應(yīng)用于臨床治療,但仍然不斷有研究結(jié)果對(duì)其療效提出不甚相同至截然相反的結(jié)論。因此,需要更加全面準(zhǔn)確的回顧性分析以及更加嚴(yán)謹(jǐn)?shù)呐R床實(shí)驗(yàn)來(lái)明確顱內(nèi)壓監(jiān)測(cè)在中重度TBI患者治療中所起的作用及意義,從而為臨床治療起到積極的指導(dǎo)作用。目的:探討有創(chuàng)動(dòng)態(tài)ICP監(jiān)測(cè)對(duì)指導(dǎo)中重度TBI患者臨床治療的應(yīng)用價(jià)值。方法:本研究選擇大連醫(yī)科大學(xué)附屬第二醫(yī)院神經(jīng)外科2015年07月至2016年09月期間收治的105例中重度TBI患者,并隨機(jī)把入選患者分為實(shí)驗(yàn)組(54例)和對(duì)照組(51例)。對(duì)照組采用傳統(tǒng)方式對(duì)顱內(nèi)壓水平進(jìn)行判定,給予常規(guī)神經(jīng)外科處置,另一組為實(shí)驗(yàn)組,均施行有創(chuàng)動(dòng)態(tài)ICP監(jiān)測(cè),根據(jù)ICP監(jiān)測(cè)的結(jié)果來(lái)指導(dǎo)制定進(jìn)一步臨床干預(yù)方案。比較實(shí)驗(yàn)組和對(duì)照組患者的性別、年齡、腎功能、TBI嚴(yán)重程度等一般資料的差異未見(jiàn)統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。最終比較兩組患者住院死亡率、甘露醇劑量及使用時(shí)間、相關(guān)并發(fā)癥發(fā)生率和預(yù)后情況四方面的對(duì)比結(jié)果,從而明確給中重度TBI患者施行有創(chuàng)動(dòng)態(tài)ICP監(jiān)測(cè)是否具有指導(dǎo)意義。結(jié)果:實(shí)驗(yàn)組在整個(gè)治療過(guò)程中住院死亡率稍低于對(duì)照組,但所使用脫水劑用量及天數(shù)、相關(guān)并發(fā)癥發(fā)生率均顯著比對(duì)照組要好(P0.01);出院后6個(gè)月患者的預(yù)后GOS評(píng)分也比對(duì)照組好(P0.05)。結(jié)論:對(duì)中重度TBI患者實(shí)施有創(chuàng)動(dòng)態(tài)ICP監(jiān)測(cè),能及時(shí)、精準(zhǔn)、客觀地反映患者的病情進(jìn)展,能為顱內(nèi)壓增高導(dǎo)致病情惡化提供早期預(yù)警,爭(zhēng)取寶貴的治療時(shí)間,便于針對(duì)不同個(gè)體及時(shí)采用有針對(duì)性的干預(yù)措施,有效消除治療上的盲目性,降低相關(guān)并發(fā)癥的發(fā)生率,并顯著改善患者預(yù)后。因此,總的來(lái)說(shuō),對(duì)中重度TBI患者實(shí)行ICP監(jiān)測(cè)利遠(yuǎn)遠(yuǎn)大于弊,對(duì)臨床診治工作具有重要的指導(dǎo)意義,值得推廣。
[Abstract]:Background: traumatic brain injury (TBI) refers to all kinds of cranial tissue injuries, including scalp, skull and brain parenchyma, caused by external violence directly or indirectly to the head. Intracranial hypertension, as the most common complication of TBI, is an important index to reflect the severity of the patient's condition, especially the increase of acute ICP caused by secondary brain injury such as hemorrhage and edema in moderate and severe acute craniocerebral injury. It is the most serious type of traumatic brain injury. It is the main cause of rapid deterioration, poor prognosis and death and disability in patients with craniocerebral trauma. Therefore, in the diagnosis and treatment of TBI patients, the changes of ICP has been the focus of neurosurgeons. Since 1960, Lundberg et al. began to apply ICP monitoring to actual diagnosis and treatment [1]. It has been more than half a century since then, and its application is more and more extensive. At present, although ICP monitoring has been widely recognized by domestic and foreign scholars and used in clinical treatment, there are still a number of research results on its efficacy is not the same or the opposite conclusion. Therefore, more comprehensive and accurate retrospective analysis and more rigorous clinical trials are needed to clarify the role and significance of intracranial pressure monitoring in the treatment of moderate and severe TBI patients, so as to play a positive guiding role in clinical treatment. Objective: to evaluate the value of invasive dynamic ICP monitoring in guiding the clinical treatment of moderate and severe TBI patients. Methods: 105 patients with moderate and severe TBI were selected from Neurosurgery Department of the second affiliated Hospital of Dalian Medical University from July 2015 to September 2016. The patients were randomly divided into two groups: experimental group (54 cases) and control group (51 cases). In the control group, the level of intracranial pressure was judged by traditional method, and the routine neurosurgical treatment was given to the other group. The other group was treated with invasive dynamic ICP monitoring. According to the results of ICP monitoring, the further clinical intervention scheme was established. There was no significant difference in sex, age and TBI severity between the experimental group and the control group (P 0.05). Finally, the hospital mortality rate, mannitol dosage and time of use, the incidence of related complications and prognosis were compared between the two groups, so as to determine the significance of dynamic ICP monitoring in patients with moderate and severe TBI. Results: the inpatient mortality rate in the experimental group was slightly lower than that in the control group, but the dosage and days of dehydrating agent used in the experimental group were lower than those in the control group. The incidence of related complications was significantly better than that of the control group (P 0.01), and the prognosis GOS score of the patients at 6 months after discharge was also better than that of the control group (P 0.05). Conclusion: the application of invasive dynamic ICP monitoring in moderate and severe TBI patients can reflect the progress of the patient's condition in time, accurately and objectively, and can provide early warning for the exacerbation of the condition caused by increased intracranial pressure and gain valuable treatment time. It is convenient for different individuals to use timely targeted intervention measures, effectively eliminate blindness in treatment, reduce the incidence of related complications, and significantly improve the prognosis of patients. Therefore, in general, the advantages of ICP monitoring for moderate and severe TBI patients are far greater than the disadvantages, which has important guiding significance for clinical diagnosis and treatment, and is worth popularizing.
【學(xué)位授予單位】：大連醫(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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