作者：曹育嘉,高山

单位：

215129 江苏省苏州市，苏州高新区人民医院神经外科 通信作者：高山，E-mail：gaoshan_sgy@163.com

Units：

Department of Neurosurgery, the People's Hospital of SND, Suzhou 215129, China Corresponding author: GAO Shan, E-mail: gaoshan_sgy@163.com

关键词：

颅脑损伤; 颅内压; 平均颅内压波幅; 甘露醇;

Keywords：

Craniocerebral injury; Intracranial pressure; Mean intracranial pressure wave amplitude; Mannitol

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.276

Funds：

苏州高新区医疗卫生科技计划青年项目（2018Q001）

摘要：

背景单纯监测颅内压(ICP)已无法满足重型颅脑损伤患者的救治需求,而平均颅内压波幅(MWA能否取代ICP作为临床药物使用的参考标准尚需要进一步探索。目的 探讨监测MWA对中重度颅脑损伤患者应用甘露醇的指导价值。方法 选取2018年12月至2020年8月苏州高新区人民医院收治的40例中重型颅脑损伤患者为研究对象,采用随机数字表法将其分为ICP组(n=23)和MWA组(n=17)。ICP组患者术后实时监测ICP,若患者ICP> 22 mm Hg则应用甘露醇。MWA组患者术后监测MWA,若患者MWA> 5 mm Hg则应用甘露醇。比较两组患者甘露醇应用总量、甘露醇应用时间、甘露醇相关并发症发生率及治疗后3个月预后。结果 两组患者甘露醇应用总量比较,差异无统计学意义(P>0.05);MWA组患者甘露醇应用时间短于ICP组(P <0.05)。两组患者急性肾衰竭、血容量不足、静脉炎及心律失常发生率比较,差异无统计学意义(P>0.05);MWA组患者高渗状态和电解质紊乱发生率低于ICP组(P <0.05)。治疗后3个月,MWA组患者预后良好者所占比例高于ICP组(P <0.05)。结论针对中重度颅脑损伤患者,将MWA> 5 mm Hg作为甘露醇应用时机,可有效缩短甘露醇应用时间,降低电解质紊乱和高渗状态发生风险,且可有效改善患者短期预后。

Abstract：

【Abstract】　Background Monitoring intracranial pressure (ICP) alone can not meet the treatment needs of patientswith severe craniocerebral injury, and whether the mean intracranial pressure wave amplitude (MWA) can replace ICP as areference standard for clinical drug use needs to be further explored.Objective To explore the guiding value of monitoringMWA in the application of mannitol in patients with moderate and severe craniocerebral trauma.Methods A total of 40 patientswith moderate and severe craniocerebral injury treated in the People's Hospital of SND from December 2018 to August 2020 wereselected as the research objects. They were randomly divided into ICP group (n=23) and MWA group (n=17) . The ICP in the ICPgroup were monitored in real time after operation, if the patient's ICP was > 22 mm Hg, mannitol was used. MWA in the MWAgroup was monitored after operation, if MWA > 5 mm Hg, mannitol was used. The total amount of mannitol application, the time ofmannitol application, the incidence of mannitol related complications and the prognosis at 3 months after treatment were comparedbetween the two groups. Results There was no significant difference in the total amount of mannitol application between thetwo groups (P > 0.05) ; the time of mannitol application in MWA group was shorter than that in ICP group (P < 0.05) . There wasno significant difference in the incidence of acute renal failure, insufficient blood volume, phlebitis and arrhythmia between thetwo groups (P > 0.05) ; the incidence of hypertonic state and electrolyte disorder in MWA group was lower than that in ICP group(P < 0.05) . At 3 months after treatment, the proportion of patients with good prognosis in MWA group was higher than that in ICPgroup (P < 0.05) . Conclusion For patients with moderate and severe craniocerebral injury, taking MWA > 5 mm Hg as theapplication time of mannitol can effectively shorten the application time of mannitol, reduce the risk of electrolyte disorder andhypertonic state, and effectively improve the short-term prognosis of patients.

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