论文部分内容阅读
目的 探讨对中型颅脑损伤患者进行颅内压无创监护的临床应用价值。方法 选取本院29例保守治疗的中型颅脑损伤患者并随机分为两组。监护组：15例，伤后依据病情每6 h进行颅内压监测以及平均动脉压监测，了解脑灌注压（CPP）的变化，并按颅内压监测情况给予甘露醇治疗以及控制CPP在60～80 mmHg之间。记录监护组的颅内压动态变化。对照组：14例，按常规治疗，静脉输注20％甘露醇125～250 mL ，6～8 h 1次，根据临床症状停止使用甘露醇或者依据临床症状及瞳孔变化行CT或进一步治疗。结果 监护组平均住院时间为（12．6±2．10）d，甘露醇使用天数为（7．6±1．59）d，用量为（5713．3±1291．75） mL ；对照组的平均住院时间为（18．71±1．33）d ，甘露醇使用天数（15±1．22）d ，甘露醇用量为（9653．57±1371．75）mL ，两组相比较差异均有显著性（ P＜0．05）。监护组中度残疾率为6．67％，对照组中度残疾率为28．57％，两组相比较差异均有显著性（ P ＜0．05） ，两组均无严重残疾以下的转归。监护组肾功能异常率为13．30％，对照组为21．40％，两组相比较差异无显著性（ P ＞0．05）。结论 颅内压无创监护有利于指导医师合理应用甘露醇。利用颅内压无创监护来维持CPP在60～80mmHg可以明显改善患者预后并缩短住院时间。对中型颅脑损伤患者的颅内压进行持续无创监护，对指导治疗、改善预后、提高疗效等有重要意义，具有较高的临床价值。“,”Objective] To explore clinical application value of noninvasive intracranial pressure monitoring in moderate brain injury .[Methods]A total of 29 patients with moderate brain injury receiving expectant treatment in our hospital were randomly divided into 2 groups .According to the condition after trauma ,the monitoring group( n=15) received intracranial pressure and mean arterial blood pressure monitoring per 6h in order to understand the change of cerebral perfusion pressure(CPP) ,and then were given mannitol with CPP at 60~80mmHg once per 6~8h according to intracranial pressure monitoring state .The dynamic change of intracranial pressure in monitoring group was recorded .Control group( n =14) received conventional therapy i .e .intravenous injection with 20 mannitol 125~250mL once per 6~8h ,and stopped mannitol according to clinical symptoms or was given CT or further therapy according to clinical symptoms and pupil change .[Results]In monitoring group ,the average hospitalization day was 12 .6 ± 2 .10d ,and the duration and dose of mannitol were 7 .6 ± 1 .59d and 5713 .3 ± 1291 .75ml ,respectively .In control group ,the average hospitalization day was 18 .71 ± 1 .33d ,and the duration and dose of mannitol were 15 ± 1 .22d and 9653 .57 ± 1371 .75 mL ,respectively .There were signifi‐cantly differences between two groups( P0 .05) .[Conclusion]Noninvasive intracranial pressure monitoring is helpful to guide physicians use mannitol reasonably .CPP at 60~80mmHg maintained by noninvasive intracranial pressure monitoring can improve the prognosis and shorten hospital stay of patients .Persistent noninvasive monitoring for patients with moderate brain injury is of vital sig‐nificance in guiding the treatment ,improving the prognosis and increasing the efficacy .Therefore ,it has high clinical value .