动态颅内压监测联合脑氧饱和度监测目标导向治疗在重型颅脑损伤中的应用

【摘要】目的探讨动态颅内压(ICP)监测联合局部脑氧饱和度（rScO2）监测目标导向治疗在重型颅脑损伤（sTBI）的临床应用价值。方法60例sTBI患者随机分为动态ICP监测联合rScO2监测目标导向治疗组（联合监测组）和对照组，每组各30例。对照组患者采用神经外科重症传统监护治疗。联合监测组患者在神经外科重症传统监护治疗的基础上予以ICP联合rScO2目标监测指导治疗。结果联合监测组患者出院时格拉斯哥昏迷量表（GCS）评分较对照组高，两组患者出院时GCS评分均较入院GCS评分高，但差异均无统计学意义（均P＞0.05）。联合监测组患者的神经外科重症监护病房（NSICU）住院时间及总住院时间均较对照组明显减少（P＜0.05~0.01）。出院后6个月时，联合监测组患者的改良Rankin量表（mRS）及格拉斯哥预后量表（GOS）评分均明显优于对照组（P＜0.05~0.01），死亡率明显低于对照组（P＜0.05）。Kaplan-Meier生存曲线分析显示联合监测组患者生存时间明显优于对照组（P＜0.05）。结论ICP联合rScO2监测目标导向治疗能有效缩短sTBI患者的总住院时间及NSICU住院时间，降低病死率，改善患者的预后。

Abstract: Objective To explore the clinical value of dynamic intracranial pressure(ICP) monitoring combined with regional cerebral oxygen saturation(rScO2) monitoring target oriented therapy for severe traumatic brain injury(sTBI). Methods 60 patients with sTBI were randomly divided into dynamic ICP monitoring combined with rScO2 monitoring target oriented treatment group(combined monitoring group) and control group,with 30 cases in each group. The patients in the control group were treated under neurosurgical intensive care. The patients in the combined monitoring group were guided by ICP combined with rScO2 target monitoring on the basis of traditional intensive care treatment in neurosurgery. Results The Glasgow coma scale(GCS) score of patients in the combined monitoring group was higher than that in the control group. The GCS score of patients in the two groups was higher than that in the admission group, but the difference was not statistically significant(all P>0.05). The length of total hospital stay and the length of stay in neurosurgical intensive care unit(NSICU) in the combined monitoring group were significantly lower than those in the control group(P<0.05~0.01). At 6 months after discharge, the scores of modified Rankin Scale(mRS) and Glasgow prognosis scale(GOS) in the combined monitoring group were significantly better than those in the control group(P<0.05~0.01), and the mortality was significantly lower than that in the control group(P<0.05). Kaplan-Meier survival curve analysis showed that the survival time of patients in the combined monitoring group was significantly better than that in the control group(P<0.05). Conclusion ICP combined with rScO2 monitoring target oriented treatment can effectively shorten the total hospital stay and NSICU stay of sTBI patients, reduce the mortality and improve the prognosis of patients.