Application Of Ventricle Type Of Intracranial Pressure Monitoring In Severe Craniocerebral Injury

【Background】 The high intracranial pressure (ICP) is the focus and difficulty in the treatment of severe craniocerebral injury (STBI). The real-time, dynamic, and accurate data of ICP could be provided by the ICP monitoring, which will be benefit in the early detection of disease changes to grasp the operation indication and the guidance on the application of dehydration drugs. The application of ICP monitoring has resulted in significantly changing the model of therapy in STBI. The Codman ICP monitoring probe producted by USA Johnson Company has two different types: simple type of ICP monitoring probe (placed in the subdural, brain parenchyma) and ventricle type of ICP monitoring probe (placed in ventricle). As the gold standard of ICP monitoring, the ventricle type of ICP monitoring in the simultaneous monitoring of intracranial pressure can effectively control intracranial hypertension by releasing intracranial cerebrospinal fluid to reduce the volume of intracranial contents. However, there were less comparative study between the two types of probe in recent years. Therefore, in this study, the advantage of clinical application of the ventricle type of ICP monitoring probe would be explored in treatment for 56 patients with STBI (GCS score 3～5) supplied by Shandong Zouping County traditional Chinese Medical Hospital from 2010 to 2014. Furthermore, comparison between two types of ICP monitoring probe was observed for the clinical treatment effect to make the best choice for ICP monitoring in STBI.[Method] The 56 patients with STBI (GCS score 3-5) admitted in Shandong Zouping County traditional Chinese Medical Hospital from May 2010 to June 2014, were performed to the bilateral decompressive craniotomy and intracranial pressure monitoring probe implantation in all patients, including 33 cases with ventricle type of ICP monitoring probe (A group) and 23 cases with simple ICP monitoring probe (B group). According to the ICP condition, the ICP in two groups was controlled in the ideal state to maintain reasonable cerebral perfusion pressure (CPP), by using the appropriate treatment to reduce intracranial pressure. These treatment measures were performed including airway patency with tracheal intubation or tracheotomy, mechanical ventilation, analgesic and sedative drugs, elevation of the head of the bed, control of body temperature and blood glucose, hypertonic treatment, high muscle tension with muscle relaxant, seizure control, maintenance of central venous pressure at 5～12cmH2O and cerebral perfusion pressure at 60-70mmHg, and so on. The data of two groups of patients was statistically analyzed in general information, GCS score, dosage and time of mannitol and postoperative prognosis after 6 months. The two groups of continuous variables are expressed in mean ± standard deviation and compared by t test. Categorical variable used Chi-square, and P<0.05 considered statistically.[Results] The using dosage and time of mannitol in A group (675±95g, 8.1±2.3 days) was obviously decreased less than B group(785 ±113g,10.3±2.5 days) for statistical significance (P<0.05). As follow up after 6 months, the result of postoperative prognosis demonstrated that:in group A, there were 7 cases (21.2%) with good recovery (GOS score 5),5 cases (15.2%) with medium disability (GOS score 4),5 cases (15.2%) with severe disability (GOS score 3),9 cases (27.2%) with plant survival (GOS score 2) and 7 cases (21.2%) with death (GOS score 1); in group B, there were 2 cases (8.7%) with good recovery (GOS score 5),1 cases (4.3%) with medium disability (GOS score 4),2 cases (8.7%) with severe disability (GOS score 3), 10 cases (43.5%) with plant survival (GOS score 2) and 8 cases (34.8%) with death (GOS score 1). Regard as good prognosis with GOS score 3-5 and poor prognosis with GOS score 1-2, the postoperative prognosis in group A of patients was much better than group B for statistical significance (P<0.05).[Conclusion] The ventricle type of ICP monitoring probe applied in STBI can significantly change the treatment modality with mannitol. Moreover, the comparation between the two types of ICP monitoring probe demonstrated the application of ventricle type of ICP monitoring is more useful to control the acute ICP and improve the prognosis of patients with STBI than simple ICP monitoring.