重型颅脑损伤后颅内压与血浆胶体渗透压变化的相关性研究

重型颅脑损伤后颅内压与血浆胶体渗透

压变化的相关性研究

【摘要】目的：探讨重型颅脑损伤患者颅内压发生变化时与血浆胶体压的变化关系。方法：对我院神经外科急救中心2017年1月至2018年1月间收治

51例重型颅脑损伤患者，全部行脑室内颅内压监测术。监测颅内压变化时患者的血浆胶体渗透压。统计颅内压变化时血浆渗透压，分析两者的相关性。结果：重型颅脑损伤后血浆胶体渗透压（COP）与颅内压（ICP）变化水平密切相关，损伤程度越严重，颅内压越高。重型组损伤早期血浆胶体渗透压水平稳定，当颅内压开始升高，血浆胶体渗透压开始下降，当颅内压变化值小于4时，血浆胶体渗透压变化不明显，当颅内压变化值大于4时，血浆胶体渗透压变化明显，血浆胶体渗透压及颅内压变化呈负相关，结论：在临床工作中如果不能进行有创颅内压监测可以用血浆胶体渗透压来预测颅内压变化。

【关键词】颅脑损伤；颅内压；血浆胶体渗透压；颅内压变化值；监测；

Correlation between intracranial pressure and plasma colloid osmotic pressure after severe head injury

Zheng Wei Zhou Yi bo Miao Liang

Department of Emergency, Shenzhen Longgang Central Hospital Shenzhen, Guangdong 518116

[abstract]Objective: to investigate the relationship between the changes of intracranial pressure and plasma colloid pressure in patients with severe craniocerebral injury.Methods: from January 2017 to January 2018, 51 patients with severe craniocerebral injury were admitted to the emergency neurosurgery center of our hospital, and all of them underwent intracranial pressure monitoring.The plasma colloid

osmotic pressure was monitored for changes in intracranial

pressure.The correlation between plasma osmotic pressure and

intracranial pressure was analyzed.Results: after severe

craniocerebral injury, there was a close correlation between COP and ICP.Heavy stable group of early damage of plasma colloid osmotic pressure level, when the intracranial pressure begins to rise, plasma colloid osmotic pressure began to fall, when the intracranial pressure change value is less than 4, the plasma colloid osmotic pressure

change is not obvious, when changes in intracranial pressure value is greater than 4, the plasma colloid osmotic pressure changes significantly, negatively correlated with plasma colloid osmotic pressure and the change of intracranial pressure,Conclusion： if not

in the clinical work of invasive intracranial pressure monitoring plasma colloid osmotic pressure can be used to predict changes in intracranial pressure.

【Key words】 Craniocerebral injury;Intracranial pressure.Plasma colloid osmotic pressure;Change in intracranial pressure;Monitoring;

颅脑损伤作为一种较为常见的外伤性疾病，具有高致残率、高致死率的特点。对于格拉斯哥昏迷量表( GCS) 评分≤8 分的重型颅脑损伤患者，其病死率高达35% ～ 45%【1】。随着颅内压监测、CT 检查以及神经重症监测治疗的应用，重型

颅脑损伤患者的死亡率已取得明显下降【2】。但是颅内压监测对操作、并发症的

管理要求严格，所以风险小，易操作的监测技术受到越来越多的关注。血浆胶体

渗透压(colloid osmotic pressure，COP)是血液生物化学检查的一项重要指标

与内容，主要是由血浆蛋白对抗血浆中水分从血管内移到血管外的一种牵引力，

防治组织水肿。正常生理状况下，COP对稳定血容量，预防组织水肿起重要作用【3】。因此本研究只在探讨在重型颅脑损伤患者颅内压与血浆胶体渗透压之间的

关系，为预测重型颅脑损伤患者病情发展寻找一种安全、快捷的方法，以利于提

高该病的临床救治成功率。