目的 探讨创伤性脑损伤(TBI)患者颅内压波动趋势对TBI预后的影响. 方法 采用回顾性病例系列研究分析2012年6月-2014年6月收治的30例TBI患者的临床资料,其中男21例,女9例;年龄(43.0±19.8)岁.在完成颅内压探头置入术后,分别对TBI患者的颅内压进行连续监测并每分钟记录一次数据.使用单一余弦法对记录的颅内压数据进行近日节律分析.选择近日节律参数振幅(A)与中值(M)的比值(A/M)来评估患者的生物节律.采用线性回归分析近日节律参数A/M与格拉斯哥昏迷评分(GCS)以及A/M与扩展格拉斯哥预后评分(GOS-E)的相关性. 结果 所有患者无论受伤的严重程度如何,监测到术后颅内压的波动均存在近日节律(P＜0.01).颅内压的近日节律参数A/M与患者出院时GCS呈正相关(R2 =0.346,F=14.797,P ＜0.01);颅内压的近日节律参数A/M与GOS-E呈正相关(R2=0.356,F=15.502,P＜0.01). 结论 TBI患者的颅内压存在近日节律;颅内压近日节律的波动趋势可能与TBI患者的预后有一定相关性.%Objective To investigate the effect of intracranial pressure fluctuation on the prognosis of patients with traumatic brain injury (TBI).Methods A retrospective case series study was conducted on the clinical data of 30 patients with TBI hospitalized between June 2012 and June 2014.There were 21 males and 9 females,aged (43.0 ± 19.8) years.After the intracranial pressure probe was implanted,the intracranial pressure of TBI patients was monitored continuously and the data were recorded per minute.A single cosine method was used in analyzing the circadian rhythm of intracranial pressure data.Furthermore,the ratio of the amplitude of the circadian parameter (A) to the median (M) value (A/M) was selected to evaluate the biologic rhythm of patients.The correlations of circadian rhythm parameter A/M with Glasgow Outcome Scale (GCS) and with extended Glasgow Outcome Scale (GOS-E) were analyzed using linear regression.Results The circadian rhythm was observed in all patients regardless of injury severity (P ＜ 0.01).The circadian rhythm parameter A/M of intracranial pressure was positively correlated with the GCS of patients at discharge (R2 =0.346,F =14.797,P ＜0.01) and with the GOS-E (R2 =0.356,F =15.502,P ＜ 0.01).Conclusion The intracranial pressure fluctuation of TBI patients follows circadian rhythm,which might be correlated with the prognosis of TBI patients.
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