Sustained intracranial pressure monitoring for prevention and treatment of kidney injury following craniocerebral trauma

Abstract

Objective To investigate effect of sustained intracranial pressure (ICP) monitoring in mannitol therapy for kidney function conservation after craniocerebral trauma.Methods A retrospective comparison was conducted on 168 patients with craniocerebral trauma treated between January 2010 and January 2012.The patients were divided into ICP monitoring group (ICP group,77patients) and non-ICP monitoring group (control group,91 patients).Changes of cystatin C,creatinine and urea in plasma were detected dynamically.Data like mannitol dosage,hospital days and GOS score at postoperative 6 months were documented.Results Two groups showed no significant differences regarding in-hospital injury condition,renal function as well as age and gender distribution.Rate of renal failure of control group was 2.2 times more than that of ICP group (P ＜ 0.05).Mannitol dosage of ICP group only accounted for 27.35％ of that of control group,ie,(443 ± 133) g:(1 620 ±412) g (P ＜0.01).Frequency of mannitol use of ICP group was obviously less than that of control group,ie,(4.8 ±3.8) days vs (7.2 ± 2.3) days (P ＜ 0.01).At 6 months postoperatively,GOS score of ICP group was significantly better than that of control group (P ＜ 0.05).Plasma levels of cystatin C and creatinine at days 7,14 and 21 and plasma levels of urea at day 14 were significantly lower of ICP group,when compared with control group (P ＜ 0.05).Conclusion ICP monitoring significantly reduces the dosage and duration of mannitol therapy for craniocerebral trauma and effectually prevents and declines the occurrence of renal failure following craniocrebral trauma. Key words: Craniocerebral trauma; Intracranical pressure ; Mannitol; Kidney function