关键词: 重型颅脑损伤, 梯度减压术, 颅内压监测, 疗效, 预后

Abstract:

Objective To analyze the clinical efficacy and prognostic impact of ventricular intracranial pressure （ICP） monitoring-assisted stepwise decompression in the treatment of patients with severe craniocerebral injury complicated with cerebral hernia， and to explore the complementary mechanism between these two interventions. Methods A total of 200 patients diagnosed with severe craniocerebral injury complicated with cerebral hernia admitted to our hospital between April 2025 and February 2026 were enrolled in this retrospective study. All patients underwent ICP probe placement and staged decompression. The control group （n = 98） received conventional standalone ICP monitoring， while the observation group （n = 102） received intraventricular ICP monitoring. Intergroup comparisons were performed on ICP control efficacy， mannitol dosage and administration， hospitalization-related indicators， clinical prognosis and the incidence of postoperative complications. Results Statistically significant differences in ICP were detected across time effect， inter-group effect， and interaction effect （all P < 0.05）. Compared with the ICP values obtained on postoperative day 1， ICP in the observation group decreased significantly on postoperative day 3 and postoperative day 7， while ICP in the control group decreased significantly only on postoperative day 7 （all P < 0.05）. Compared with the ICP values on postoperative day 3， ICP in both groups decreased significantly on postoperative day 7 （P < 0.05）. Throughout postoperative day 1， postoperative day 3， and postoperative day 7， ICP in the observation group was consistently lower than that in the control group （all P < 0.05）. Compared with the control group， the observation group exhibited statistically significant reductions in mannitol dosage， duration of mannitol administration， length of intensive care unit （ICU） stay， and total length of hospital stay （all P < 0.05）. The median Glasgow Outcome Scale （GOS） score of the observation group ［4.00 （2.00， 4.00）］ was significantly higher than that of the control group ［3.00 （2.00， 4.00）］ （Z = -3.489， P < 0.001）. Classified by GOS scores， 24 patients in the observation group and 11 patients in the control group achieved favorable prognoses， with the observation group showing a significantly higher proportion of favorable outcomes （P < 0.05）. Postoperative complications assessed in this study included acute encephalocele， intracranial infection， renal dysfunction， and delayed hematoma. The incidence of delayed hematoma， acute malignant encephalocele， and the overall complication rate in the observation group were significantly lower than those in the control group （all P < 0.05）. No statistically significant between-group difference was observed in the incidence of intracranial infection or renal dysfunction （both P > 0.05）. Conclusions The combination of ventricular ICP monitoring and stepwise decompression exerts a synergistic effect， and achieves favorable clinical outcomes in patients with severe craniocerebral injury complicated with cerebral hernia. This combined strategy can effectively control intracranial hypertension， reduce the dosage of mannitol， shorten hospital length of stay， improve patient prognosis， and reduce the incidence of postoperative complications.

Key words: severe craniocerebral injury, stepwise decompression, intracranial pressure monitoring, efficacy, prognosis