Effect Of The Combination Of Invasive Intracranial Pressure And Transcranial Doppler Monitoring In Treatment For Posttraumatic Acute Diffuse Brain Swelling

Objective To explore the combined effect of invasive intracranial pressure(ICP)and transcranial Doppler(TCD)monitoring in treatment for posttraumatic acute diffuse brain swelling(PADBS)and brain protection.Methods The clinical data of 120 patients with PADBS,admitted in the Neurosurgery Department of the 98 th Hospital of PLA from January 2014 to January 2016,were retrospectively analyzed.There were 88 males and 32 females,aged 19~70 years(mean,43.6 years).Traffic injury in 71 cases,high fall injury in 29 cases and other injury in 20 cases.Of the 120 cases analyzed,61 had GCS score of 3~8,37 had GCS score of 9~12 and 22 had GCS score of 13~14 at admission.Patients were divided into three groups based on if they have accepted invasive ICP and TCD,i.e.Group A(37 cases),neither invasive ICP nor TCD;Group B(40 cases),with invasive ICP only;Group C(43 cases),with both ICP and TCD.The hospitalization time in ICU,better prognosis(GOS 4~5),Barthel index(BI),and mini-mental status examination(MMSE)12 months after injury,as well as,the mydriasis rata,and the decreased values of GCS between admission and start of operation were compared among the 3 groups.Results(1)The hospitalization time in ICU were 9.6 ± 6.8 d,9.2± 5.4 d,and 8.9 ± 5.7 d(P > 0.05)respectively in the three groups.The ratio of better prognosis were respectively 46%(17/37),65%(26/40)and 72%(31/43),i.e.the prognosis in group B and C was better than that of group A(P<0.05);however,there was no significant difference between group B and C(P> 0.05).The BI were 51.0±36.7,58.0±35.7 and 70.2±34.6,as well,the MMSE were 17.3 ± 12.5,18.8 ± 12.0 and 21.2±11.4,respectively in the three groups.Both BI and MMSE in group B and C were higher than that of group A(P <0.05),moreover,those in group B were also statistically lower than those in group C(P <0.05).(2)The ratio of mydriasis after adimission but before operation were respectively 33%(9/27),13%(4/30),and 7%(2/28)in the three groups,where it was higher in group A than that in group B and C(P<0.05).But there were no statistical differences between group B and group C(P> 0.05).The decreased values of GCS between admission and start of operation in each group were respectively 1.4±1.3,0.7±0.5,and 0.6±0.4,the results showed that the values of GCS in group A decreased significantly than that of group B and C,(P<0.05).However,there were no statistical difference between group B and C(P> 0.05).Conclusion Application of invasive ICP and TCD monitoring in PADBS patients might present a timely and precise condition changes,and it could improve the prognosis,daily activity abilities and cognitive function by protecting the brain function.