颅内压监测在高血压脑出血微创治疗中的应用  

Value of intracranial pressure monitoring in minimally invasive surgery for hypertensive intracerebral hemorrhage

作　　者：韦拳堂[1] 钟志伟[1] 张子衡[1] 黄杰浩 许益民[1] 

机构地区：[1]汕头大学医学院第一附属医院神经外科,515041

出　　处：《实用医学杂志》2016年第7期1136-1139,共4页The Journal of Practical Medicine

摘　　要：目的:探索颅内压(ICP)监测在高血压脑出血(HICH)微创术中及术后治疗中的指导价值和优势。方法:抽取73例HICH的病例,随机分配为对照组和治疗组(ICP监测组)。对照组34例,术中使用立体定向软通道技术对血肿进行穿刺,抽吸术前计算血肿量的1/3～1/2后停止,术后常规血肿腔内注射尿激酶;治疗组39例,血肿穿刺前放置ICP监测,然后对血肿进行控制性抽吸,设定目标ICP为15 mm Hg,达到目标ICP则停止抽吸,术后根据ICP监测数值控制性血肿腔内注射尿激酶2～5万单位等治疗方案。通过对比两组患者术后再出血的发生率、血肿排空时间、平均住院时间等,评判ICP控制在HICH的价值。结果:通过治疗组观察发现,要达到预期治疗效果的ICP,术中抽吸初始血肿量的1/5左右即可;术后再出血:治疗组0例,对照组4例,差异有统计学意义。两组血肿排空用时:治疗组(7.36±2.06)d,对照组(10.00±2.59)d,差异有统计学意义。平均住院时间:治疗组(19.45±5.942)d,对照组(25.52±9.881)d,差异有统计学意义。结论:持续ICP监测联合定向软通道微创手术治疗HICH,改变既往术中经验性抽吸血肿和术后推注药物的观念,提出控制性引流和注药的理念,抽吸初始血肿量的1/5左右(约4～10 m L),即可降低ICP至目标值,还可明显减少术后再出血的发生,缩短病程,减少并发症发生,缩短患者住院时间,并为临床上提供灵敏、客观的指标和依据,提高疗效,减少继发性损伤,改善预后。Objective To explore the value and advantage of intracranial pressure（ICP） monitoring in the treatment of hypertensive intracerebral hemorrhage（HICH） through minimally invasive surgery. Methods Seventythree HICH cases were randomly selected and then divided into control group and treatment group. Thirty-four of them in control group received soft-channel minimally invasive hematoma removal. The head of the soft-channel was placed in the center of the hematoma. One third to half of the initial hematoma was extracted during the operation. Urokinase was injected into the soft channel to dissolve the hematoma. Thirty-nine of them in treatment group underwent the same operation procedure but with ICP monitoring to control aspirating hematoma during the operation. The target ICP was 15 mm Hg. The aspiration of hematoma may stop once the ICP down to the target.Treatment such as urokinase injection was adjusted according to the value of ICP monitoring throughout the operation. The incidence of rebleeding, hematoma evacuation time and the average length of stay between two groups were compared. Results The results showed that one fifth of hematoma extracted was enough for a desired ICP. There found no rebleeding case in treatment group while 4 cases in control group and the difference had statistical significance. The hematoma evacuation time and the average length of stay between two groups had statistical significance. Conclusion Continuous ICP monitoring combined with directional software channel minimally invasive surgery changes the concept of empirically intraoperative hematoma evacuation and postoperative drug injection and proposes the idea of controlling drainage. It can shorten the course, provide sensitive and objective indicators and basis, reduce the secondary brain injury and improve prognosis.

关 键 词：脑出血 颅内压监测 控制性抽吸 高血压 微创手术 

分 类 号：R651.12[医药卫生—外科学] R544.1[医药卫生—临床医学]