颅内压监测对重度颅脑外伤行开颅血肿清除术患者GCS评分、并发症及预后的影响

摘要

目的 探讨颅内压监测对重度颅脑外伤开颅血肿清除术后患者GCS评分、并发症及预后的影响.方法 选取重度颅脑外伤患者84例,将以上患者分成常规组和监测组.常规组患者行标准外伤大骨瓣开颅减压术,监测组患者则在行标准外伤大骨瓣开颅减压术的基础上联合术后颅内压监测.比较2组患者手术前后格拉斯哥昏迷评分(GCS)、颅内压变化、术后并发症发生情况以及预后.结果 监测组患者术后3、7 d的颅内压下降值显著大于常规组(P<0.05);2组患者术后28 d GCS评分均显著升高,且监测组患者GCS评分升高较常规组更显著(P<0.05);与常规组相比,术后3个月的格拉斯哥预后评分(GOS)提示监测组的预后较好(P<0.05);术后6个月,常规组与监测组的电解质紊乱发生率分别为59.5%、33.3%(P<0.05).结论 对重度颅脑外伤患者行标准外伤大骨瓣开颅减压术联合术后颅内压监测的疗效较好.%Objective To explore the influence of intracranial pressure monitoring on GCS score,complications and prognosis of severe traumatic brain injury patients with trauma craniectomy.Methods A total of 84 patients with STBI were randomly divided into two groups.The routine group was treated with standard large trauma craniectomy,and monitoring group was treated with trauma craniectomy combined with intracranial pressure monitoring.The change of intra-carnial pressure before and after operation,GCS scores change,prognosis as well as post operative complications were compared between two groups.Results Compared with routine group,the intra-carnial pressure at 3rd and 7th day after operation in monitoring group significantly decreased (P<0.05),and the GCS score at 28th day improved after operation in both groups,and increasing degree of monitoring group was significantly higher than the routine group (P<0.05).The GCS score at 3rd month after operation indicated that the prognosis in monitoring group was significantly better than routine group (P<0.05).The incidence rates of electrolyte disturbance in monitoring group and routine group at 6 month after surgery were 59.5% and 33.3% respectively (P<0.05).Conclusion Standard trauma craniectomy combined with intracranial pressure monitoring treatment is effective in treatment of patients with severe traumatic brain injury.