摘要： 目的 探讨脑室型颅内压监测及相关流程管理在双侧额叶挫裂伤中的应用价值。方法 纳入2010年1月至2016年1月解放军联勤保障部队第九〇四医院收治的387例双侧额叶挫裂伤患者,105例行脑室型颅内压监测(ICP组)、282例未行脑室型颅内压监测(无ICP组),分别接受保守治疗和手术治疗(包括单侧开颅挫裂伤和血肿清除术、双侧开颅挫裂伤和血肿清除术、去骨瓣减压术),记录保守治疗成功率、双侧开颅手术和去骨瓣减压术比例、住院时间、住院费用以及住院期间相关并发症发生率,术后6个月采用Glasgow预后分级评价预后。结果 与无ICP组相比,ICP组保守治疗成功率较高[64.76%(68/105)对47.16%(133/282);χ²=9.493,P=0.002],去骨瓣减压术比例较低[8.11%(3/37)对23.49%(35/149);χ²=4.314,P=0.038],住院时间较短[(13.22 ± 1.83) d对(18.51 ± 5.08) d;t=10.410,P=0.000],住院费用较低[(8.34 ± 3.26)万元对(9.67 ± 4.42)万元;t=2.811,P=0.005];而手术方式(χ²=2.673,P=0.102),住院期间肺部感染[33.33%(35/105)对39.72%(112/282);χ²=1.321,P=0.250]、颅内感染[10.48%(11/105)对8.16%(23/282);χ²=0.513,P=0.473]、脑积水[3.81%(4/105)对6.74%(19/282);χ²=1.173,P=0.279]、癫发作[6.67%(7/105)对10.99%(31/282);χ²=1.617,P=0.203]、心动过缓[28.57%(30/105)对34.75%(98/282);χ²=1.320,P=0.251]发生率,预后差异均无统计学意义(χ²=1.492,P=0.474)。结论 双侧额叶挫裂伤患者病情进展迅速,应及时行脑室型颅内压监测并流程管理。虽然脑室型颅内压监测无法改善最终预后,但可增加保守治疗成功率、降低去骨瓣减压术比例、缩短住院时间、减少住院费用,值得临床推广应用。

关键词: 脑挫伤, 额叶, 颅内压, 神经外科手术

Abstract: Objective To investigate clinical efficacy and optimal therapeutic strategy for ventricular intracranial pressure (ICP) monitoring and process management in patients with traumatic bifrontal contusions (TBC). Methods Total 387 TBC patients between January 2010 and January 2016 were enrolled in 904th Hospital of Chinese PLA, in which 105 patients with TBC who underwent ventricular ICP monitoring (ICP group) and 282 patients with TBC who did not (non-ICP group). Conservative treatment and surgical treatment were performed respectively (unilateral craniotomy for contusion and hematoma removal, bilateral craniotomy for contusion and hematoma removal, and decompressive craniotomy). Rates of successful conservative treatment, ratio of bilateral craniotomy and decompressive craniectomy, length of stay, medical expenses and incidence of related complications were compared between 2 groups. Glasgow Outcome Scale (GOS) was used to assess all patients after 6 months follow-up. Results Compared with non-ICP group, ICP group had a significantly better successful conservative treatment rate[64.76% (68/105) vs. 47.16% (133/282); χ²=9.493, P=0.002], lower decompressive craniectomy rate[8.11% (3/37) vs. 23.49% (35/149); χ²=4.314, P=0.038]; shorter length of stay[(13.22 ± 1.83) d vs. (18.51 ± 5.08) d; t=10.410, P=0.000] and lower medical expenses[(8.34 ± 3.26) ten thousand yuan vs. (9.67 ± 4.42) ten thousand yuan; t=2.811, P=0.004]. No significantly difference in operative methods (χ²=2.673, P=0.102), pulmonary infection[33.33% (35/105) vs. 39.72% (112/282); χ²=1.321, P=0.250], intracranial infection[10.47% (11/105) vs. 8.16% (23/282); χ²=0.513, P=0.473], hydrocephalus[3.81% (4/105) vs. 6.74% (19/282); χ²=1.173, P=0.279], epilepsy[6.67% (7/105) vs. 10.99% (31/282); χ²=1.617, P=0.203] and bradycardia[28.57% (30/105) vs. 34.75% (98/282); χ²=1.320, P=0.251]. There were no significant differences in prognosis between 2 groups (χ²=1.492, P=0.474). Conclusions Condition of patients with TBC progresses rapidly. Patients should undergo ventricular ICP probe implantation in a timely manner. Although ventricular ICP monitoring do not significantly improve the prognosis of patients, it can increase the success rate of conservative treatment, reduce the rate of decompressive craniectomy, shorten the length of stay, and reduce the medial expenses. Ventricular ICP monitoring warrants further clinical research.

Key words: Brain contusion, Frontal lobe, Intracranial pressure, Neurosurgical procedures