颅内压监测在破裂颅内动脉瘤夹闭手术中的应用  

Application of intracranial-pressure monitoring for ruptured intracranial aneurysm clipping operations

作　　者：张珏[1] 费智敏[1] 书国伟[1] 王静予[1] 蔡佩浩[1] 邱锋[1] 许乐宜[1] 孔令军[1] 龚立[1] 谭晓辉[1] 于淼[1] 马佳涛 

机构地区：[1]上海中医药大学附属曙光医院神经外科,上海201203

出　　处：《上海交通大学学报（医学版）》2015年第5期707-709,713,共4页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市教委课题(13ZZ094);上海市中医药事业发展三年行动计划(ZYSNXD012-RC-ZXY001);上海高校青年教师培养资助计划(Zzszy13025)~~

摘　　要：目的探讨颅内压监测在破裂颅内动脉瘤夹闭手术中的应用价值。方法 57例破裂动脉瘤患者开颅手术夹闭术中植入基本型或脑室导管型颅内压监测探头,术后根据颅内压监测指导药物治疗和脑脊液引流。对患者预后及并发症发生情况进行分析。结果 42例患者术后颅内压始终低于20 mm Hg（1 mm Hg=0.133k Pa）;13例患者根据颅内压监测结果给予甘露醇脱水,增加脑脊液引流后颅内压低于20 mm Hg;1例脑内血肿患者通过二次手术治疗后好转;1例大面积梗死患者死亡。术后随访3~6个月,CT检查发现11例（19.3%）患者存在不同程度脑积水,放置脑室导管型颅内压探头患者脑积水的发生率为15.22%,显著低于放置基本型颅内压探头患者的36.36%（P〈0.05）。结论颅内压监测,特别是脑室导管型颅内压监测可以观察破裂动脉瘤夹闭术后病情变化,指导治疗,减少并发症的发生。Objective To explore the application value of intracranial-pressure （ICP） monitoring for ruptured intracranial aneurysm clipping operations. Methods A total of 57 patients with ruptured intracranial aneurysm underwent the clipping operation with ICP monitoring （basic or venticular catheter kit） implanted. The post- operative drug treatment and cerebral-spinal fluid （CSF） drainage were based on the ICP monitoring. The prognosis and complications of patients were analyzed. Results The post-operative ICP of 42 patients was constantly below 20 mmHg （i mmHg =0. 133 kPa）. Thirteen patients underwent mannitol treatment and CSF drainage according to the results of ICP monitoring and their ICPs maintained below 20 mmHg. One patient with intra-cerebral haematoma underwent a second operation and the symptoms were relieved. One patient with serious infarction died. Patients were followed up for 3 -6 months after operation. CT examinations showed that there were 11 patients （19.3%） with different degrees of hydrocephalus. The incidence of hydrocephalus of patients who implanted the venticular catheter kit was 15. 22%, which was significantly lower than that （36.36%） of patients who implanted the basic catheter kit （P 〈0.05）. Conclusion ICP monitoring, especially the venticular catheter kit, can monitor the post-operative condition of ruptured intracranial aneurysm clipping operation, guide the treatment, and reduce complications.

关 键 词：颅内压监测 动脉瘤夹闭 脑积水 

分 类 号：R651.15[医药卫生—外科学]