摘要目的:探讨颅脑外伤后脑疝患者在梯度减压术前应用脑室型颅内压监测(V-ICPM)的临床价值。方法:选择解放军联勤保障部队第九〇〇医院神经外科自2016年10月至2020年10月收治的颅脑外伤后脑疝患者103例，根据减压前是否应用V-ICPM分为观察组和对照组，观察组共49例，采用梯度减压术前联合V-ICPM治疗；对照组共54例，采用常规梯度减压术治疗。比较2组患者恶性脑膨出的发生率、远近期疗效及并发症发生情况。根据患者颅内压(ICP)值将其分为正常或轻度增高(≤22 mmHg)、中度增高(23~40 mmHg)及重度增高(>40 mmHg)，分析患者ICP值与预后的关系。结果:(1)观察组和对照组患者术中恶性脑膨出的发生率分别为16.33%、29.63%，差异无统计学意义( P>0.05)。术后24 h时观察组患者瞳孔恢复35例(71.43%)，对照组患者瞳孔恢复28例(51.85%)，差异有统计学意义( χ2=4.145， P=0.042)。术后24 h时观察组及对照组患者格拉斯哥昏迷量表(GCS)评分分别为(8.43±2.56)分、(7.39±2.47)分，差异有统计学意义( t=-2.095， P=0.039)。术后3个月时观察组患者中格拉斯哥预后量表(GOS)评分5分7例，4分18例，3分10例，2分8例，1分6例；对照组5分12例，4分17例，3分12例，2分7例，1分6例；差异无统计学意义( Z=-0.681， P=0.496)。(2)无论是初始ICP还是剪开硬脑膜时ICP，数值较高患者预后均较差。 结论:梯度减压术前应用V-ICPM未能进一步改善患者远期预后，但可为术者提供术中参考和预后预测。

abstractsObjective:To investigate the clinical value of ventricular intracranial pressure monitoring (V-ICPM) in gradient decompression for patients with traumatic cerebral hernia.Methods:The clinical data of 103 patients with traumatic cerebral hernia admitted to our hospital from October 2016 to October 2020 were retrospectively analyzed. These patients were divided into observation group ( n=49) and control group ( n=54) according to whether V-ICPM was applied. Patients in the observation group accepted V-ICPM before gradient decompression, and patients in the control group accepted gradient decompression directly. Incidence of malignant encephalocele, clinical short-term and long-term efficacies, and complications were compared between the two groups. According to intracranial pressure (ICP), the patients were divided into normal or slightly increased ICP (≤22 mmHg), moderate increased ICP (23-40 mmHg) and severe increased ICP (>40 mmHg); the relationship between ICP and prognoses was analyzed in the observation group. Results:(1) The incidences of intraoperative malignant encephalocele in the observation group (16.33%) were slightly lower than that in the control group (29.63%), without significant difference ( P>0.05). Twenty four h after gradient decompression, pupils recovered in 35 patients (71.43%) from the observation group and 28 patients (51.85%) from the control group, significant difference in the pupils recovery rate was noted between the two groups ( χ2=4.145, P=0.042); the Glasgow Coma Scale (GCS) scores between the observation group (8.43±2.56) and control group (7.39±2.47) showed statistical differences ( t=-2.095, P=0.039). Three months after gradient decompression, there were 7 patients with Glasgow Outcome Scale (GOS) scores of 5, 18 patients with scores of 4, 10 patients with scores of 3, 8 patients with scores of 2, and 6 patients with score of 1 in the observation group; there were 12 patients with GOS scores of 5, 17 patients with scores of 4, 12 patients with scores of 3, 7 patients with scores of 2, and 6 patients with score of 1 in the control group; the difference was not statistically significant ( Z=-0.681, P=0.496). (2) The higher the ICP in the observation group (initially and when the dura mater is cut), the worse the prognosis. Conclusion:The application of V-ICPM before gradient decompression cannot further improve the long-term prognosis of the patients, but it can provide intraoperative reference and prognosis prediction for the operators.