天津医药

天津医药 ›› 2019, Vol. 47 ›› Issue (5): 493-496.doi: 10.11958/20181607

• 临床研究 • 上一篇    下一篇

颅内压监测对创伤性脑损伤患者短期预后及急性肾损伤发生的影响

贺倩 1，李蕃健 2，赵子龙 2，马菲 3△   

  1. 基金项目：国家自然科学基金资助项目（81601068）；天津市自然科学基金资助项目（17JCQNJC12100） 作者单位：1天津医科大学总医院检验科（邮编300052），2神经外科；3天津医科大学公共卫生学院流行病与卫生统计学系 作者简介：贺倩（1981），女，主管技师，主要从事神经系统疾病临床医学检验与转化研究 △通讯作者 E-mail: mafei@tmu.com.cn
  • 收稿日期:2018-10-22 修回日期:2019-03-25 出版日期:2019-05-15 发布日期:2019-05-15
  • 通讯作者: 马菲 E-mail:506364638@qq.com
  • 基金资助:
    线粒体微粒在创伤性脑损伤相关凝血功能障碍中的作用机 制研究;线粒体微粒激活血小板介导颅脑创伤相关凝血功能障碍的机制研究

Effects of intracranial pressure monitoring on short-term outcome and acute kidney injury in traumatic brain injury

HE Qian1, LI Fan-jian2, ZHAO Zi-long2, MA Fei3△   

  1. 1 Department of Medical Laboratory, 2 Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China; 3 Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University △Corresponding Author E-mail: mafei@tmu.com.cn
  • Received:2018-10-22 Revised:2019-03-25 Published:2019-05-15 Online:2019-05-15

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摘要： 摘要：目的 探讨颅内压监测（ICP）对创伤性脑损伤（TBI）患者短期预后及急性肾损伤（AKI）发生的影响。方 法 选取天津医科大学总医院神经外科创伤性脑损伤患者351例，其中ICP监测患者101例，无ICP监测患者250例。 回顾性观察2组患者短期预后改善、呼吸机使用时间、重症监护病房（ICU）住院时间、住院时长、急性肾损伤发生率、 20%甘露醇使用总量和临床生化检验结果的差异。进一步分析中型（n=160）和重型TBI（n=189）患者中应用和未应 用ICP监测的临床特征。结果 ICP监测组患者AKI发生率及20%甘露醇使用量、血红蛋白、总蛋白和白蛋白水平低 于无ICP监测组，呼吸机使用时间、ICU住院时间长于无ICP监测组（P＜0.05）；2组短期预后改善率及住院时间、球蛋 白、肌酐和尿素氮水平差异无统计学意义。在重型TBI亚组中，ICP监测组（n=55）AKI发生率显著低于无ICP监测组 （n=134），呼吸机使用时间及尿素氮水平高于无ICP监测组（P＜0.05）；在中型TBI亚组中，ICP监测组（n=44）住院时 间、ICU住院时间和呼吸机使用时间均长于无ICP监测组（n=116，P＜0.05）。结论 ICP监测可减少患者AKI发生率 及20%甘露醇使用量，有助于TBI患者出入量平衡得到更精确控制。

关键词: 颅内压, 创伤性脑损伤, 急性肾损伤, 回顾性分析

Abstract: Abstract: Objective To study the effects of intracranial pressure (ICP) monitoring on short-term prognosis and acute kidney injury (AKI) in traumatic brain injury (TBI). Methods Data of 351 patients with TBI in department of neurosurgery of Tianjin Medical University General Hospital were retrospectively studied including 101 patients with ICP monitoring and 250 TBI patients without ICP monitoring. Data of the short-term prognosis, ventilator use time, intensive care unit (ICU) stay, hospitalization time, length of hospital stay, total 20% mannitol usage, the incidence of AKI, the total use of 20% mannitol and the difference of clinical biochemical test results were retrospectively analyzed. The patients were further divided into the medium (n=160) and the severe TBI (n=189) subgroups for analysis of some clinical features. Results There were lower incidence rates of AKI, total 20% mannitol usage, levels of hemoglobin and total protein and albumin in ICP monitoring group than those of no ICP monitoring group (P＜0.005). And there were longer mechanical ventilation days and ICU stay in ICP monitoring group compared to those of no ICP monitoring group (P＜0.005). There were no significant differences in short-term prognostic improvement rate, hospitalization time, globulin, creatinine and urea nitrogen levels between the two groups. In TBI subgroup, the incidence of AKI was significantly lower in ICP monitoring group (n=55) than that of no ICP monitoring group (n=134), but the time of ventilator use and urea nitrogen level were higher in ICP monitoring group than those of no ICP monitoring group (P＜0.05). In medium TBI subgroup, the hospitalization time, ICU hospitalization time and ventilator usage time were significantly higher in ICP monitoring group (n=44) than those of no ICP monitoring group (n=116, P＜0.05). Conclusion It is found that ICP monitoring can reduce the incidence of AKI and 20% mannitol usage, and have a benefit effect on helping to obtain more precise control of the electrolyte and fluid balance in TBI patients.

Key words: intracranial pressure, traumatic brain injury, acute kidney injury, retrospective studies