持续有创颅内压监测在颅后窝血肿手术的应用  

Application of continuous and invasive intracranial pressure monitoring in posterior cranial fossa hematoma surgery

作　　者：程传东[1] 牛朝诗[1] 魏祥品[1] 计颖[1] Cheng Chuandong;Niu Chaoshi;Wei Xiangpin;Ji Ying(Department of Neurosurgery,Anhui Provincial Hospital,Anhui Province Key Laboratory of Brain Function and Brain Disease,Anhu)

机构地区：[1]安徽省立医院神经外科、脑功能与脑疾病安徽省重点实验室、安徽省脑立体定向神经外科研究所,合肥230001

出　　处：《中国微侵袭神经外科杂志》2018年第8期340-343,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：安徽省自然科学基金青年项目(编号:1508085QH184)

摘　　要：目的探讨持续有创颅内压监测在颅后窝血肿手术的应用价值与临床意义。方法回顾性分析急诊收治的20例颅后窝血肿病例资料,其中外伤2例,自发性脑出血18例。均先行侧脑室穿刺外引流联合颅内压监测电极置入,再行后入路血肿清除术。根据颅内压结果动态调整治疗方案。结果全组无死亡病例,无非计划二次手术病例。颅内压监测3～10 d,平均6.2 d。无探头置入引起的颅内出血。1例病人术后出现颅内感染,经腰大池持续引流对症处理后治愈。随访1～12个月,根据GOS评价预后:良好16例,中残3例,重残1例。结论颅后窝血肿手术联合持续动态颅内压监测优势明显,可减少颅内感染发生率,调整治疗方案,观察疗效与预后转归。因此,具有广阔临床应用前景,值得推广。Objective To explore the applied value and clinical significance of sustained intracranial pressure（ICP） monitoring in posterior cranial fossa hematoma surgery. Methods Clinical data of 20 patients with posterior cranial fossa hematoma were analyzed retrospectively. There were 2 traumatic brain injury cases and 18 spontaneous cerebellar hemorrhage cases. All the patients underwent unilateral external ventricular drainage in combination with ICP monitoring electrode placement before the hematoma was evacuated.The surgical strategies and treatment options were regulated based on the variation of ICP. Results No deaths and unplanned second surgery occurred. ICP monitoring underwent 3 to 10 days and averaged 6.2 days. There was no severe intracranial hemorrhage caused by ICP monitoring electrode and intracranial infection occured in 1 case who was cured by continuous lumbar drainage. All the patients were followed up from 1 to 12 months. According to Glasgow Outcome Score（GOS）, good recovery was achieved in 16 cases, moderate disability seen in 3 and severe disability in 1. Conclusions Continuous and dynamic monitoring of ICP is equipped with obvious advantages that could contribute to decreasing the rate of intracranial infection, adjusting treatment options and observing the therapeutic effect and prognosis of patients with posterior cranial fossa hematoma. Therefore, it has the broad prospects of clinical application and is worthy of being generalized.

关 键 词：血肿 颅内压监测 有创性 颅后窝 

分 类 号：R651.15[医药卫生—外科学]