He Jianqing, Chen Junhui, Wu Ting, Zhang Chunlei, Yang Likun, Shi Zhong-Hua, Wang Yu-Hai
Department of Neurosurgery, Wuxi Medical College of Anhui Medical University, Chinese PLA joint services of 904th Hospital (l0lth Hospital of PLA), Wuxi.
Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan.
J Craniofac Surg. 2019 Oct;30(7):2217-2223. doi: 10.1097/SCS.0000000000005861.
This study aimed to investigate the clinical efficacy of intracranial pressure (ICP) monitoring regarding the perioperative management of patients with severe traumatic brain injury (sTBI). This was a cohort study performed between Jan 2013 and Jan 2016 and included all patients with sTBI. All patients were split into ICP monitoring and non-ICP monitoring groups. The primary outcomes were in-hospital mortality and Glasgow Outcome Scale (GOS) scores 6 months after injury, whereas the secondary outcomes include rate of successful nonsurgical treatment, rate of decompression craniotomy (DC), the length of stay in the ICU, and the hospital and medical expenses. This retrospective analysis included 246 ICP monitoring sTBI patients and 695 without ICP monitoring sTBI patients. No significant difference between groups regarding patient demographics. All patients underwent a GOS assessment 6 months after surgery. Compared to the non-ICP monitoring group, a lower in-hospital mortality (20.3% vs 30.2%, P < 0.01) and better GOS scores after 6 months (3.3 ± 1.6 vs 2.9 ± 1.6, P < 0.05) with ICP monitoring. In addition, patients in the ICP monitoring group had a lower craniotomy rate (41.1% vs 50.9%, P < 0.01) and a lower DC rate (41.6% vs 55.9%, P < 0.05) than those in the non-ICP monitoring group. ICU length of stay (12.4 ± 4.0 days vs 10.2 ± 4.8 days, P < 0.01) was shorter in the non-ICP monitoring group, but it had no difference between 2 groups on total length of hospital stay (22.9 ± 13.6 days vs 24.6 ± 13.6 days, P = 0.108); Furthermore, the medical expenses were significantly higher in the non-ICP monitoring group than the ICP monitoring group (11.5 ± 7.2 vs 13.3 ± 9.1, P < 0.01). Intracranial pressure monitoring has beneficial effects for sTBI during the perioperative period. It can reduce the in-hospital mortality and DC rate and also can improve the 6-month outcomes. However, this was a single institution and observational study, well-designed, multicenter, randomized control trials are needed to evaluate the effects of ICP monitoring for perioperative sTBI patients.
本研究旨在探讨颅内压（ICP）监测在重度创伤性脑损伤（sTBI）患者围手术期管理中的临床疗效。这是一项于2013年1月至2016年1月期间进行的队列研究，纳入了所有sTBI患者。所有患者被分为ICP监测组和非ICP监测组。主要结局指标为住院死亡率和伤后6个月的格拉斯哥预后评分（GOS），次要结局指标包括非手术治疗成功率、去骨瓣减压术（DC）率、重症监护病房（ICU）住院时间、住院时间及医疗费用。这项回顾性分析纳入了246例接受ICP监测的sTBI患者和695例未接受ICP监测的sTBI患者。两组患者的人口统计学特征无显著差异。所有患者在术后6个月均接受了GOS评估。与非ICP监测组相比，接受ICP监测的患者住院死亡率更低（20.3%对30.2%，P<0.01），6个月后的GOS评分更高（3.3±1.6对2.9±1.6，P<0.05）。此外，ICP监测组患者的开颅率（41.1%对50.9%，P<0.01）和DC率（41.6%对55.9%，P<0.05）均低于非ICP监测组。非ICP监测组的ICU住院时间更短（12.4±4.0天对10.2±4.8天，P<0.01），但两组患者的总住院时间无差异（22.9±13.6天对24.6±13.6天，P=0.108）；此外，非ICP监测组的医疗费用显著高于ICP监测组（11.5±7.2对13.3±9.1，P<0.01）。颅内压监测在sTBI围手术期具有有益作用。它可以降低住院死亡率和DC率，还可以改善6个月后的预后。然而，这是一项单中心观察性研究，需要设计良好的多中心随机对照试验来评估ICP监测对sTBI围手术期患者的影响。
