动态颅内压监测对去骨瓣减压术后重度高血压脑出血患者预后的影响  

Effect of dynamic intracranial pressure monitoring on the prognosis of patients with severe hypertensive cerebral hemorrhage after decompressive craniectomy

作　　者：于德强 YU Deqiang(Department of Neurosurgery,the People's Hospital of Dengfeng,Dengfeng 452470,China)

机构地区：[1]登封市人民医院神经外科,河南登封452470

出　　处：《中国实用神经疾病杂志》2019年第4期419-425,共7页Chinese Journal of Practical Nervous Diseases

摘　　要：目的研究动态颅内压监测对去骨瓣减压术后重度高血压脑出血患者预后的影响。方法选取登封市人民医院2013-12—2015-12治疗的重度高压脑出血患者68例,所有患者行去骨瓣减压术,根据患者入院顺序编号,采用随机数表法分为观察组与对照组,每组34例,观察组患者进行动态颅内压监测。比较2组术后甘露醇使用剂量、住院时间、术后并发症发生率及病死率,以及治疗前后白介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、神经元特异性烯醇化酶(NSE)等血清生化指标水平;应用日常生活能力评分表(ADL)评定患者远期预后。结果观察组术后甘露醇使用总剂量较对照组小,住院时间较对照组短(P<0.05);观察组术后并发症发生率29.41%,较对照组的55.88%明显降低(P<0.05);术后10 d观察组IL-6、hs-CRP、NSE等血清生化指标水平较对照组低(P<0.05);观察组术后半年ADLⅠ～Ⅱ级患者占75.76%,较对照组的48.28%明显较高(P<0.05)。结论对行去骨瓣减压术的重度高血压脑出血患者实施动态颅内压监测,能及时发现病情变化,有效应用药物降压,降低了患者术后并发症发生率,改善远期预后。Objective To study the effect of dynamic intracranial pressure monitoring on the prognosis of patients with severe hypertensive cerebral hemorrhage after decompressive craniectomy. Methods Sixty eight patients with severe hypertensive cerebral hemorrhage who were admitted to the hospital between December 2013 and December 2015 were studied.All patients underwent decompressive craniectomy.According to the order of admission,the patients were numbered and were randomly divided into the observation group and the control group by the random number table method,34 cases in each group.The observation group were given dynamic intracranial pressure monitoring,while the control group were not monitored.The dosage of mannitol after operation,length of hospital stay,incidence rates of postoperative complications,mortality rates,the levels of interleukin-6 (IL-6),high sensitivity C reactive protein (hs CRP),neuron specific enolase (NSE) and other serum biochemical indexes were compared between the two groups.The long term prognosis of patients was evaluated with activities of daily living scale (ADL). Results The total dose of mannitol in observation group after operation was significantly less than the control group,and the length of hospital stay was significantly shorter than the control group (P<0.05).The incidence rate of postoperative complications in the observation group (29.41%) was significantly lower than that in the control group (55.88%)(P<0.05).10d after operation,the levels of serum biochemical indexes (IL-6,hs CRP,NSE) were significantly lower than those in the control group (P<0.05).Six months after operation,the probability of gradeⅠ~Ⅱ ADL in the observation group (75.76%) was significantly higher than that in the control group (48.28%)(P<0.05). Conclusion The application of dynamic monitoring of intracranial pressure in patients with severe hypertensive cerebral hemorrhage after decompressive craniectomy can timely find the changes of patient's condition,and the effective use of antihypertensive drugs

关 键 词：高血压脑出血 动态颅内压监测 去骨瓣减压手术 

分 类 号：R743.34[医药卫生—神经病学与精神病学]