Invasive Intracranial Pressure Monitoring In Craniocerebral Trauma

BackgroundCraniocerebral trauma refers to the direct or indirect effects of external violence on the head,which is divided into open and closed injury according to whether the brain tissue is connected with the outside world after injury.Common brain injuries include scalp laceration,scalp hematoma,skull fracture,concussion,contusion and laceration,intracranial hematoma and so on.Patients with craniocerebral trauma are complicated and rapidly changing,and are prone to cause adverse consequences,some patients need surgical treatment.The complications of craniocerebral trauma after craniotomy will directly affect the prognosis of the patients.The increase of the intracranial pressure makes the cerebral perfusion pressure decrease,the cerebral blood flow is reduced,and the brain metabolism is seriously affected.Once the brain hernia occurs,it will endanger the patient's life.If we can find the increase of intracranial pressure in time,we should take effective measures to relieve intracranial pressure and solve the cause of increased intracranial pressure.Intracranial pressure monitoring,as the first direct and invasive brain monitoring technique,was first applied to the clinic in 1960 by Professor Lundberg,and the application of this monitoring technique in the diagnosis and treatment of craniocerebral trauma is increasing.ObjectiveTo investigate the clinical application of invasive intracranial pressure monitoring after craniocerebral trauma operation.Methods61 cases conducted craniocerebral trauma operation were selected from Jan.2015 to Jun.2016 in our hospital.Codman intracranial pressure monitor was used intraoperative.Intracranial pressure date was continuously observed and recorded postoperative.Meanwhile,patients' awareness,pupil and vital signs was observed strictly.The therapy plan could be decided or adjusted in time according to the monitoring results.ResultsUnder the monitoring of intracranial pressure,the dosage and frequency of dehydrated drugs and the related treatment plan are timely adjusted to effectively control the symptoms of cerebral edema and cranial pressure symptoms after operation.Most of the patients recover well.25 cases of normal intracranial pressure in the first day after operation in this group,without the use of dehydrating agents,the rest of the patients were using different doses of intracranial pressure lowering drugs such as mannitol,furosemide,albumin and glycerol fructose.The application of time for 2 to 11 days.One of the cases died on the day of the operation,the cause of death was the brain stem function of acute failure,of which 3 cases in the monitoring process found a sudden increase in intracranial pressure.Considering delayed intracranial hematoma or brain contusion hematoma increased.Timely review emergency skull CT confirmed diagnosis and secondary surgery.Correlation analysis results showed that there was a negative correlation between intracranial pressure and GCS(r=-0.643,P<0.05).The relationship between the intracranial pressure before dehydration at the first day after surgery in patients and the prognosis 6 months later was observed and it was found that the higher the intracranial pressure,the worse the prognosis(x2 =9.55,P<0.05).ConclusionsThe invasive intracranial pressure monitoring is the most rapid,objective and accurate method.It is also an important method such as to observe the change of patients' condition,early diagnosis,determine the timing of the operation,guiding clinical drug treatment,to judge and improve prognosis.In summary,it is worth attention and promotion.