[隆德概念在重型颅脑损伤后脑水肿治疗中的应用]

[Application of Lund concept in treating brain edema after severe head injury].

作者信息

Liu Chang-Wen, Zheng Yong-Ke, Lu Jun, Yu Wen-Hua, Wang Bo, Hu Wei, Zhu Ke-Yi, Zhu Ying, Hu Wei-Hang, Wang Jian-Rong, Ma Jian-Ping

机构信息

Department of Crit Care Medicine, Hangzhou First People's Hospital, Hangzhou 310006, Zhejiang, China.

出版信息

Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2010 Oct;22(10):610-3.

PMID:20977845

Abstract

OBJECTIVE

To explore if the new treatment with Lund concept could reduce the mortality of patients after severe brain injury.

METHODS

This study included 68 severe brain injury patients in whom Gloasgow coma score (GCS) was 3-8, and in 30 of them Lund concept was adopted, and the other 38 patients were taken care of by the conventional treatment in controlling intracranial pressure (ICP). Furthermore, in patients of the Lund group and control group ICP and cerebral perfusion pressure (CPP) were monitored continuously for 5 days.

RESULTS

The amount of mannitol (g) used was markedly smaller in Lund group than that in the control group (139.6±25.0 vs. 587.5±31.8, P<0.01). The 28-day mortality of Lund group was significantly lower than that in control group (30.0% vs. 57.9%, P<0.05). In Lund group, the incidence of ICP exceeding 25 mm Hg (1 mm Hg=0.133 kPa) or 35 mm Hg or lowering of CPP by 50 mm Hg observed in the non-survivors (n=9) was greater than that observed in the survivors [n=21, (45.0±23.2)% vs. (7.2±3.6)%, (40.2±18.6)% vs. (2.2±1.6)%, (35.9±12.9)% vs. (3.1±2.4)%, all P<0.05].

CONCLUSION

By adopting the Lund concept, it is possible to reduce postoperative mortality after severe head injury.

摘要

目的

探讨采用隆德概念的新治疗方法能否降低重型颅脑损伤患者的死亡率。

方法

本研究纳入68例格拉斯哥昏迷评分（GCS）为3 - 8分的重型颅脑损伤患者，其中30例采用隆德概念治疗，另外38例采用传统方法控制颅内压（ICP）。此外，对隆德组和对照组患者连续5天监测ICP和脑灌注压（CPP）。

结果

隆德组甘露醇使用量（克）明显少于对照组（139.6±25.0 vs. 587.5±31.8，P<0.01）。隆德组28天死亡率显著低于对照组（30.0% vs. 57.9%，P<0.05）。在隆德组中，非幸存者（n = 9）中观察到ICP超过25 mmHg（1 mmHg = 0.133 kPa）或35 mmHg或CPP降低50 mmHg的发生率高于幸存者[n = 21，（45.0±23.2）% vs. （7.2±3.6）%，（40.2±18.6）% vs. （2.2±1.6）%，（35.9±12.9）% vs. （3.1±2.4）%，均P<小于0.05]。