摘要
Abstract
Objective To observe the impact of intraoperative dynamic intracranial pressure monitoring and cerebral hemodynamic indices on the prognosis of patients with severe traumatic brain injury undergoing decompressive craniectomy.Methods A retrospective analysis was conducted of 60 patients with severe traumatic brain injury who underwent decompressive craniectomy at Xiangcheng County People's Hospital from June 2018 to March 2020.According to the 6-month extended GlasgowOutcomeScale-Extended(GOSE),patients were divided into a good-outcome group(GOSE≥5,n=23)and a poor-outcome group(GOSE≤4,n=37).All patients underwent decompressive craniectomy combined with intracranial hematoma evacuation under general anesthesia with endotracheal intubation.Intraoperative dynamic intracranial pressure was monitored after bone flap removal and after dural closure,and middle cerebral artery hemodynamic parameters at bone flap removal were recorded,including peak systolic velocity(PSV),end-diastolic velocity(EDV),mean flow velocity(Vmean),resistive index(RI),and pulsatility index(PI).Logistic regression was used to analyze the relationships between intraoperative dynamic intracranial pressure and intracranial hemodynamic indices and prognosis.Results Dynamic intracranial pressure after bone flap removal and after dural closure was lower in the good-outcome group than in the poor-outcome group(P＜0.05).Vmean and EDV were higher and RI was lower in the good-outcome group compared with the poor-outcome group(P＜0.05).There were no significant differences in PSV or PI between groups(P＞0.05).Logistic regression showed that intracranial pressure after bone flap removal(OR=3.544,95％CI 1.803～11.598),intracranial pressure after dural closure(OR=11.475,95％CI 1.752～75.153),Vmean(OR=0.054,95％CI 0.003～0.897),and EDV(OR=0.117,95％CI 0.014～0.957)were factors associated with prognosis(P＜0.05).Receiver operating characteristic(ROC)curve analysis showed that the areas under the curve(AUCs)of intracranial pressure after bone flap removal,intracranial pressure after dural closure,Vmean,and EDV for predicting prognosis were 0.786,0.861,0.690,and 0.790,respectively.Conclusion Intraoperative changes in dynamic intracranial pressure and specific cerebral hemodynamic parameters are closely associated with prognosis in patients with severe traumatic brain injury undergoing decompressive craniectomy.Real-time monitoring of these trends,especially maintaining appropriate intracranial pressure and cerebral hemodynamic status,can inform clinical decision-making,facilitate timely adjustment of treatment,and improve patient outcomes.关键词
重型颅脑外伤/去大骨瓣减压术/动态颅内压监测/颅内血流动力学Key words
severe craniocerebral injury/decompressive craniectomy/dynamic intracranial pressure monitoring/intracranial hemodynamics分类
医药卫生
