临床神经外科杂志2018，Vol.15Issue(2)：128-133,6.DOI:10.3969/j.issn.1672-7770.2018.02.011
CT环池分级结合颅内压监测在颅脑损伤手术前后的临床应用
Research of cisterna ambiens classification on CT image combined with continuous monitoring of intracranial pressure for pre-and postoperative patients after traumatic brain injury
摘要
Abstract
Objective To research the value of cisterna ambiens classification of CT imaging and intraoperative continuous monitoring of intracranial pressure(ICP)in patients with severe traumatic brain injury(sTBI)before and after operation.Methods ICP monitoring and brain CT examination of twenty-five patients who underwent craniectomy after severe traumatic brain injury were performed.The ICP value and cisternal grades were recorded,and cisterna ambiens degree was classified as followings:GradeⅠ:The central pool of occlusion;GradeⅡ:0.1-1.0 mm;GradeⅢ:1.0-2.0 mm;Grade Ⅳ:>2.0 mm.Five point Glasgow outcome(GOS)was used for outcome assessment after six months after operation.Outcome is further classified into favourable(GOS scores 4,5)and unfavourable(GOS scores 3 to 1)for analysis.Then,statistical analyses were performed based on these factors(cisternal grades,ICP and prognosis).Results Cisternal grade was found to be not influencing the outcome of patients with severe traumatic brain injury before operation.Found a negative correlation between basal cisterns classification and ICP level after operation;and the lower the basal cisterns classification,the higher the ICP,The difference between different groups is statistically significant.Found a correlation between cisterna ambiens classifications, ICP level and prognosis.Strongest correlation was found between prognosis and ICP 72 hafter operation.The ICP value of unfavourable prognosis group is much significantly higher than the ICP value of favourable prognosis group.Having found that ICP72 his a strong predictor outcome(considering favourable outcome).ROC curve was made for finding out the optimal cutoff(ICP72 h=21 mmHg)as a predictor.Conclusions Cisterna ambiens classification can reflect ICP level,and ICP72 his superior to cisterna ambiens classification for assessing prognosis of craniectomy patients with traumatic brain injury.Cisternal grade and continuous ICP in the treatment of preoperative and postoperative patients with sTBI contribute to identify problems timely and guide therapy and assess prognosis,and play an important clinical value treatment of sTBI patients.关键词
重型颅脑损伤/神经外科手术/CT环池/颅内压/预后Key words
severe traumatic brain injury/neurosurgical procedures/CT cisterna ambiens/intracranial pressure/prognosis分类
医药卫生引用本文复制引用
张艺滨,郑艺芳,李光海,陈良鑫,陈小燕,郑婉玲..CT环池分级结合颅内压监测在颅脑损伤手术前后的临床应用[J].临床神经外科杂志,2018,15(2):128-133,6.基金项目
2014泉州卫生科研资助项目[(2014)267-34] （2014）
泉州科技计划项目(2015Z51) （2015Z51）
