目的 分析脑室型颅内压（ICP）监测辅助梯度减压术治疗重型颅脑损伤伴脑疝患者临床疗效及预后，分析两者互补机制。 方法 回顾性选取医院2025年4月至2026年2月收治的重型颅脑损伤伴脑疝患者作为研究对象，共200例。所有患者均行颅内压监测探头置入术+梯度减压术治疗，对照组（n = 98）采用单纯型ICP监测，观察组（n = 102）采用脑室型ICP监测。比较两组颅内压控制情况、甘露醇使用情况、住院情况、预后及并发症发生情况。 结果 两组患者ICP在时间、组间、交互效应比较上差异有统计学意义（P < 0.05）；与术后1 d比较，观察组术后3、7 d的ICP均降低，对照组术后7 d的ICP降低（P < 0.05），与术后3 d比较，两组术后7 d的ICP降低（P < 0.05），观察组术后1、3及7 d的ICP均低于对照组（P < 0.05）；观察组甘露醇使用量及使用时间均少于对照组（P < 0.05）；观察组入住重症监护室（ICU）时间以及总住院时间均短于对照组（P < 0.05）；观察组平均格拉斯哥预后（GOS）评分为4.00（2.00，4.00）分，显著高于对照组的平均GOS评分3.00（2.00，4.00）分（Z = -3.489，P < 0.001）；经GOS评分评估，观察组、对照组预后良好的患者分别为24例（23.5%）、11例（11.2%），观察组预后优于对照组（P < 0.05）；两组术后发生的并发症包括切口急性脑膨出、颅内感染、肾功能不全等，观察组迟发性血肿、急性恶性脑膨出以及总并发症发生率低于对照组（P < 0.05），两组颅内感染、肾功能不全发生率差异无统计学意义（P > 0.05）。 结论 脑室型ICP监测辅助梯度减压术两者发挥协同作用，在重型颅脑损伤伴脑疝患者中发挥良好的效果，有效控制颅内高压、减少甘露醇使用量、缩短住院时间、改善预后，降低并发症发生率，具有良好的临床应用价值。

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.