Evaluation Of The Application Effect Of Monitoring Intracranial Pressure After Decompressive Craniectomy For Traumatic Brain Injury

OBJECTIVE: To investigate the clinical application effects of intracranial pressure monitoring in patients with severe craniocerebral injury,understand the changes of postoperative intracranial pressure,and guide the use of postoperative dehydration drugs in patients with craniocerebral injury.Methods: In this study,select 23 patients with craniocerebral injury(GCS-score 3-8 points)during the period of September 2014 to September 2016 in Ningxia Medical University Hospital.All patients were admitted within 24 hours after injury,given examination of brain CT and unilateral standard decompression of the bone flap.Adopted Prospective research methods to the 10 cases with intracranial pressure monitor placed under the dural after the surgery while the other 13 cases are severe head injury in the same period without intracranial pressure monitor placed under the dural after the unilateral standard decompression of the bone flap.After the surgery,the two groups were given acid,rehydration and other conventional treatment.Meanwhile,the ICP monitoring group records numerical values of intracranial pressure per hour and adjust the amount of mannitol on the basis of the change of intracranial pressure.The control group was treated with mannitol according to routine treatment.Observe dosage of mannitol of the two groups,renal function,water and electrolyte disorder and intracranial pressure changes of monitoring group within seven days after surgery.Results:(1)The total dose of mannitol was(575.00 ± 102.06)g in the ICP group and(815.38 ± 163.47)g in the control group,the digital analysis was statistically significant(t =-4.319,P = 0.000).The total usage time of mannitol was 22.80 ± 9.93 days in the monitoring group and 25.08 ± 11.30 days in the control group,so there was no significant difference in the number of days(t =-0.504,P = 0.619).(2)There were 1 case of renal insufficiency and 2 cases of disturbance of water and electrolyte in the ICP group.The statistical data of the same symptom is respectively 8 cases,9 cases in the control group.So these differences were statistically significant.(3)Through continuous observation of the ICP changes for 7 days after the surgery,it is found that there is a certain rule.And we could determine the progress and prognosis of patients through the change of ICP.Most patients’ ICP had no obvious rise in the 4 hours after surgery,the ICP increased to about 15~20mm Hg within 12 hours.The effect of mannitol dehydration on reducing intracranial pressure was significant,which could cause the ICP to drop or remain relatively stable.The patients’ ICP peaked at 48 hours after surgery,and ICP maximum appeared on the first 3~5 days after surgery ranging from 25 to 35 mm Hg.However,ICP value can reach 35~40mm Hg among a small number of patients.After the treatment of mannitol,ICP can be decreased and maintained in a relatively stable state and patient vital signs are relatively stable.From the fifth day after surgery on,the ICP began to decline.According to Glasgow Outcome Score(GOS),the number of good recovery,light disability,severe disability is respectively 2 cases,2 cases and 5 cases.One patient’s ICP value continually increased to 30~40mm Hg in the 1~4 hours after the surgery.After giving dehydration and other symptomatic treatment,there is no significant improvement in reducing intracranial pressure.Therefore,Surgical treatment was done again after emergency examination of brain CT.The changes in intracranial pressure of the patient was the same as the other 9 patients.Glasgow outcome score showed that the case was in a plant state after 20 days.(4)According to Glasgow’s prognosis score,there were 2 case of good recovery,2 cases of light disability,5 cases of severe disability and 1 case in plant state in the monitoring group after 20 days of the surgery.In the control group,the statistical data of postoperative recovery is respectively 2 cases,4 cases,6 cases,1case.From the results we can see that there were more light disabilities in control group than the monitoring group,but the contrast was not statistically significant.Conclusions:(1)The datas of ICP monitoring can reduce the morbidity of such complications as acute renal insufficiency,water and electrolyte disorders caused by dehydrated drugs,which lays a good foundation for the recovery of the patients to a certain degree.(2)Intracranial pressure of these patients with severe craniocerebral injury has some certain change rule within 7 days after the operation.Numerical values of ICP usually reach peak in 3~5 days.Therefore,we can estimate the patients’ prognosis through the ICP level and duration.(3)ICP monitoring can effectively find the changes of intracranial pressure,which win a valuable treatment time for those patients needing re-operation and may have a good effect on its prognosis.