蛛网膜下腔出血患者无创颅内压监测与脑功能状态相关性及其应用研究  

Non-invasive intracranial pressure monitoring and brain function changes in patients with subarachnoid hemorrhage

作　　者：李肖亮[1] 杜波[1] 单爱军[1] 陈东 吕文 梁建 钟贤良[1] 

机构地区：[1]暨南大学第二医学院深圳市人民医院急诊科,深圳518020 [2]暨南大学第二医学院深圳市人民医院神经外科,深圳518020

出　　处：《中华神经医学杂志》2013年第4期393-397,共5页Chinese Journal of Neuromedicine

基　　金：深圳市科技局计划项目（201203130）

摘　　要：目的研究蛛网膜下腔出血（SAH）患者早期有创颅内压监测（腰椎穿刺测压或脑室外引流测压）与无创颅内压监测[闪光视觉诱发电位（F．VEP）监测]的差异性和适用性，并探讨颅内压、GCS评分与脑状态监测仪获取的数字化脑电信号[脑状态指数（csI）、肌电指数（EMG）]之间的相关性。方法对深圳市人民医院神经外科自2011年3月至2011年12月收治的33例GCS评分3～12分SAH患者早期行腰椎穿刺测压或脑室外引流测压，同步进行F．VEP无创颅内压监测及脑功能状态监测．分析无创与有创颅内压监测值是否存在差异以及上述指标间的相关性。结果f1）患者有创颅内压监测（腰椎穿刺测压／脑室外引流测压）与无创监测结果比较差异均无统计学意义（r=0．069，P=-0．946；r=-0．158，P=0．876）。（2）患者颅内压与CSI呈负相关关系（F=0．898，P〈0．000），与EMG呈正相关关系（r=O．938，P=-0．000）；GCS评分与CSI存在正相关关系（F0．472，P=-0．011），与颅内压暂未发现相关关系（r=-0．047，P=-0．8141，与EMG不存在相关关系（r=0．170，P=-0．388）。控制颅内压、GCS评分因素后偏相关分析发现CSI和EMG无相关关系（r=0．288，P=-0．138）。结论（1）SAH患者F．VEP监测颅内压与腰椎穿刺测压法或脑室外引流测压法监测具有相似效用。（2）CSI和EMG与颅内压具有良好相关性，表明病情变化与颅内压动态变化趋势相一致。Objective To analyze the differences and feasibility of non-invasive inlracranial pressure monitoring and invasive intracranial pressure monitoring in patients with subarachnoid hemorrhage （SAH） at early stage, an explore the correlation of intracranial pressure and scores of Glasgow Coma Scale （GCS） with digital electroencephalogram data （cerebral state index [CSI], eleetromyographie [EMG]） obtained by cerebral state monitoring （CSM）. Methods Synchronous line of 33 patients with SAH, having 3-12 GCS scores, was chosen in our study; early invasive intracranial pressure monitoring （lumbar puncture manometry/ventricular drainage manometry） and non-invasive intracranial pressure monitoring （flash visual evoked potential [F-VEP] monitoring）, and brain function condition monitoring （CSI and EMG） were performed on these patients; the difference of non-invasive and invasive monitoring and the correlation of intracranial pressure with these indicators were analyzed. Results Non-invasive and invasive intracranial pressure monitoring results showed no significant difference in patients with SAH（t=-0.069, P=-0.946; t=-0.158, P=-0.876）. The intracranial pressure was negatively correlated with CSI （r=-0.898, P=-0.000） and positively correlated with EMG （r=0.938, P=- 0.000）; GCS scores showed positive correlation with CSI （r=0.472, P=0.011） and showed no relation with intraeranial pressure and EMG （r= -0.047, P=-0.814; r=-0.170, P=0.388）. In addition, after intracranial pressure being controlled and GCS scores being adjusted, partial correlation analysis indicated that CSI and EMG had no correlation （r= 0.288, P=-0.138）. Conclusion Spontaneous F-VEP monitoring results have a high correlation with the results of lumbar puncture manometry and ventricular drainage manometry; intracranial pressure has correlation with CSI and EMG; dynamic intracranial pressure monitor trends are consistent with the changes of disease condition.

关 键 词：蛛网膜下腔出血 颅内压 闪光视觉诱发电位 脑功能状态 

分 类 号：R651.15[医药卫生—外科学]