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目的探讨脑室内颅内压持续监测对重型颅脑损伤后颅内压增高治疗的指导意义及阶梯式干预治疗的效果。方法对上海市神经外科急救中心2004年11月至2006年1月间收治128例重型颅脑损伤患者,其中GCS 3～5分55例,6～8分73例全部行脑室内颅内压监测术,116例行Codman脑室探头置入颅内压监测术,12例行Camino脑室探头颅内压监测术。根据颅内压变化予以相应的阶梯式治疗,以达到理想的颅内压控制及维持脑灌注压。结果预后良好72例(56.3%);中残12例(9.4%);重残23例(18.0%);植物状态10例(7.8%);死亡11例(8.6%)。结论脑室内颅内压监测下通过阶梯式治疗能有效控制颅内压,维持脑灌注压,降低重型颅脑外伤的病残率和死亡率。
Objective To investigate the guiding significance of continuous monitoring of intracranial pressure in patients with intracranial hypertension after intracranial hypertension and the effect of stepped intervention. Methods A total of 128 patients with severe craniocerebral injury were enrolled in Shanghai Emergency Department of Neurosurgical Surgery from November 2004 to January 2006. Among them, 55 cases were treated with GCS 3 ~ 5, 73 cases with 6 ~ 8 cases were diagnosed intracranial pressure 116 patients underwent intracranial pressure monitoring with Codman’s ventricular probe, and 12 underwent intracranial pressure monitoring with Camino’s ventricular probe. According to changes in intracranial pressure to the corresponding ladder treatment, in order to achieve the desired control of intracranial pressure and maintain cerebral perfusion pressure. Results The prognosis was good in 72 cases (56.3%), moderate residual in 12 (9.4%), severe disability in 23 cases (18.0%), vegetative state in 10 cases (7.8%) and death in 11 cases (8.6%). Conclusion Intravenous intracranial pressure monitoring can effectively control intracranial pressure, maintain cerebral perfusion pressure and reduce the morbidity and mortality of severe craniocerebral trauma through stepped treatment.