颅内压监测技术在创伤性颅脑损伤治疗中的应用

doi:10.3877/cma.j.issn.2095-9141.2023.04.009

颅内压（ICP）是颅腔的内容物对颅腔壁产生的压力。当创伤性颅脑损伤（TBI）患者的ICP持续增高时，可能会引起一系列神经损害，甚至形成脑疝致呼吸循环衰竭而死亡。而以ICP监测为主的多模态监测技术的出现，使临床医师在救治TBI患者时能够实时动态地监测ICP及其相关参数变化。目前有创监测技术以脑室型ICP监测为主，结果最为准确；而多种新型无创监测技术也受到广泛关注和研究。本文主要针对多模态ICP监测技术在TBI治疗中的应用展开综述，并结合文献比较各种监测技术的优劣，为临床选择相应监测方法提供依据。

关键词: 创伤性颅脑损伤, 颅内压, 多模态监测技术, 经颅多普勒超声

Intracranial pressure (ICP) is the pressure exerted by the contents of the skull cavity on the wall of the skull cavity. When ICP levels continue to increase in patients with traumatic brain injury (TBI), it may cause a series of nerve damage, and even lead to brain herniation leading to respiratory and circulatory failure and death. The emergence of multi-modal monitoring technology based on ICP monitoring enables clinicians to dynamically and real-time monitor the changes of ICP and related parameters in the treatment of TBI patients. At present, invasive monitoring techniques mainly focus on ventricular type ICP monitoring, with the most accurate results; while many new non-invasive monitoring techniques have also been widely concerned and studied. This article mainly reviews the application of multimodal ICP monitoring technology in TBI treatment, and compares the advantages and disadvantages of various monitoring technologies based on literature, providing a basis for clinical selection of corresponding monitoring methods.

Key words: Traumatic brain injury, Intracranial pressure, Multi-modal monitoring technology, Transcranial doppler

表1 ICP及相关的多模态监测技术优缺点

Tab.1 Advantages and disadvantages of ICP and related multi-modal monitoring techniques

监测方法	主要功能	准确性	应用性	感染风险	出血风险	成本消耗	操作难度	参考文献
脑室型ICP	脑室外引流，ICP监测	高	高	高	高	高	中	[8]
TCD	监测脑血流	中	高	低	低	低	高	[20]
ONSD	检查视神经鞘直径大小	中	高	低	低	低	高	[21]
CT/MRI	检查颅内病变	中	高	低	低	低	低	[22]
FVEP	皮层诱发电位	中	中	低	低	低	高	[23]
无创头感颅内压监测仪	ICP监测	中	高	低	低	高	中	[24]
PbtO₂	监测脑氧	中	中	高	中	高	高	[25]
SjvO₂	监测脑氧	低	低	高	中	高	高	[26]
NIRS	监测脑氧	低	低	低	低	高	高	[27]
CMD	监测脑代谢	低	低	中	中	中	高	[28]
cEEG	监测脑电活动	低	低	低	低	中	高	[29]

表1 ICP及相关的多模态监测技术优缺点

Tab.1 Advantages and disadvantages of ICP and related multi-modal monitoring techniques

监测方法	主要功能	准确性	应用性	感染风险	出血风险	成本消耗	操作难度	参考文献
脑室型ICP	脑室外引流，ICP监测	高	高	高	高	高	中	[8]
TCD	监测脑血流	中	高	低	低	低	高	[20]
ONSD	检查视神经鞘直径大小	中	高	低	低	低	高	[21]
CT/MRI	检查颅内病变	中	高	低	低	低	低	[22]
FVEP	皮层诱发电位	中	中	低	低	低	高	[23]
无创头感颅内压监测仪	ICP监测	中	高	低	低	高	中	[24]
PbtO₂	监测脑氧	中	中	高	中	高	高	[25]
SjvO₂	监测脑氧	低	低	高	中	高	高	[26]
NIRS	监测脑氧	低	低	低	低	高	高	[27]
CMD	监测脑代谢	低	低	中	中	中	高	[28]
cEEG	监测脑电活动	低	低	低	低	中	高	[29]

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Application of intracranial pressure monitoring technique in the treatment of traumatic brain injury

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Application of intracranial pressure monitoring technique in the treatment of traumatic brain injury