颅脑创伤开颅手术后脑池颅内压监测初步探讨

doi:10.3969/j.issn.1672-6731.2020.07.007

摘要/Abstract

摘要：

目的初步探讨颅脑创伤开颅手术后脑池开放引流监测颅内压（ICPc）与脑室外引流监测颅内压（ICPv）的相关性和一致性。方法以2019年5月至2020年7月行开颅血肿清除术的4例颅脑创伤患者作为观察对象，术后第1~7天同时行脑池开放引流和脑室外引流颅内压监测，Pearson相关分析和Bland-Altman一致性检验探讨二者的相关性和一致性。结果 4例患者术后分别获得有效颅内压测值106、87、56和99次，脑室外引流颅内压测值分别为（14.72 ±5.98）、（11.10 ±4.49）、（27.29 ±6.06）和（12.63 ±5.36）mm Hg，脑池开放引流测值为（14.32 ±5.44）、（11.20 ±4.36）、（25.46 ±5.00）和（12.46 ±5.21）mm Hg。4例患者术后脑池开放引流与脑室外引流颅内压均呈正相关（r=0.977，P=0.000；r=0.961，P=0.000；r=0.892，P=0.000；r=0.970，P=0.000）；二者平均差值为（0.21 ±1.36）mm Hg，95% LoA为-2.440~2.870（P=0.003）。结论脑室外引流与脑池开放引流颅内压监测具有良好的相关性和一致性，脑池开放引流颅内压监测可用于颅脑创伤患者的临床诊断与治疗，并有望成为脑室外引流颅内压监测的备选方案。

关键词: 脑损伤, 创伤性, 颅内压, 脑脊髓液, 引流术

Abstract:

Objective To explore the feasibility and accuracy of cisternal intracranial pressure (ICPc) monitoring after craniotomy in traumatic brain injury (TBI). Methods Four TBI patients underwent evacuation of hematoma were enrolled from May 2019 to July 2020. Ventriculostomy and cisternotomy were performed besides evacuation, and intracranial pressure (ICP) were monitored via the methods of extraventricular drainage (EVD) and cisternal drainage (CD) simultaneously for 7 d after craniotomy. The correlation and consistency between ICPc and ventricular ICP (ICPv) were observed. Results The mean values of ICPv were (14.72 ±5.98), (11.10 ±4.49), (27.29 ±6.06) and (12.63 ±5.36) mm Hg, respectively. The mean values of ICPc were (14.32 ±5.44), (11.20 ±4.36), (25.46 ±5.00) and (12.46 ±5.21) mm Hg, respectively. The correlation coefficients were 0.977 (P=0.000), 0.961 (P=0.000), 0.892 (P=0.000) and 0.970 (P=0.000), respectively. Using Bland-Altman consistency evaluation, the mean ICP difference between ICPv and ICPc was (0.21 ±1.36) mm Hg, 95% LoA was-2.440-2.870 (P=0.003). Conclusions ICPc and ICPv have good linear correlation and consistency. ICP monitoring through the method of cisternotomy and drainage can be applied to the clinical management of patients with TBI, and is likely to become an alternative method for ICPv.

Key words: Brain injuries, traumatic, Intracranial pressure, Cerebrospinal fluid, Drainage

刘俊, 张述升, 王伟, 郭芳, 王均伟, 王博, 李中振, 张国斌. 颅脑创伤开颅手术后脑池颅内压监测初步探讨[J]. 中国现代神经疾病杂志, 2020, 20(7): 597-601.

LIU Jun, ZHANG Shu-sheng, WANG Wei, GUO Fang, WANG Jun-wei, WANG Bo, LI Zhong-zhen, ZHANG Guo-bin. Preliminary clinical study on cisternal intracranial pressure monitoring after craniotomy in traumatic brain injury[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(7): 597-601.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I7/597

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Preliminary clinical study on cisternal intracranial pressure monitoring after craniotomy in traumatic brain injury

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Preliminary clinical study on cisternal intracranial pressure monitoring after craniotomy in traumatic brain injury

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