颅内压监测指导下程序化镇静在重症颅脑损伤治疗中的作用

Role of procedural sedation guided by intracranial pressure monitoring in the treatment of severe craniocerebral injury

摘要:

目的：探讨有创颅内压监测指导下程序化镇静在重症颅脑损伤治疗作用。方法：收集我院2006年7月至2014年7月期间300例患者，根据实施方案不同分为3组（常规组、镇静组、联合组）。收集治疗前后格拉斯哥昏迷评分（Glasgow coma score，GCS）差值、住院天数、简易智力状况检查量表（mini-mental status examination，MMSE）评分、Barthel指数（Barthel index，BI）评分差异和再出血发生率、病死率、肺部感染率资料，建立Excel数据库。3组再出血率、病死率和肺部感染率比较采用卡方检验。GCS差值、住院天数、MMSE评分和BI评分采用方差分析。结果：3组比较时各观察指标差异均有统计学意义。其中，GCS差值在常规组、镇静组、联合组两两比较差异有统计学意义（P<0.05）；在常规组和联合组中住院天数、MMSE评分、BI评分和病死率差异有统计学意义（P<0.05）；在镇静组和联合组中MMSE评分、BI评分和病死率比较差异有统计学意义（P<0.05）；在常规组和镇静组中，再出血率、肺部感染率差异有统计学意义（P<0.05）。结论：颅内压监护下程序化镇静更有利于改善重症颅脑损伤预后，缩短治疗时间，降低患者肺部感染以及再出血。

Abstract:

Objective：To investigate the efficacy of procedural sedation under the guidance of intracranial pressure monitoring in the treatment of severe craniocerebral injury. Methods：Totally 300 patients in our hospital from July 2006 to July 2014 were divided into 3 groups（conventional group，sedation group and combination group）. Glasgow coma score（GCS） before and after the treatment，hos－pitalization days，mini-mental status examination scale（MMSE） score，Barthel index（ＢＩ） score，rebleeding，mortality，lung infection data were recorded and Excel database was established. Rebleeding，mortality and lung infection rates of three groups were compared using χ2 test；GCS difference，hospitalization days，MMSE score and BI score were analyzed using analysis of variance. Results：There were statistically significant differences in all indicators mentioned above among three groups. GCS difference were significantly dif－ferent between conventional group，sedative group and combination group（P<0.05）. There were statistically significant differences in hospitalization days，MMSE score，BI score and mortality between sedative group and combination group（P<0.05）. There were statisti－cally significant differences in rebleeding rate and lung infection rate between sedative group and conventional group（P<0.05）. Con－clusion：intracranial pressure monitoring procedural sedation is more conducive to improving the prognosis of severe traumatic brain injury，shortening treatment time and reducing lung infection and bleeding in patients.