有创颅内压监测在大面积脑梗死患者手术治疗中的应用  

Application value of invasive intracranial pressure monitoring in the surgical treatment of large area cerebral infarction

作　　者：吴文昌[1] 吴雪松[1] 潘荣南[1] 梁远志 覃家敏[1] WU Wenchang;WU Xuesong;PAN Rongnan;LIANG Yuanzhi;QIN Jiamin(Department of Neurosurgery, The First People's Hospital of Yulin,Yulin 537000,Guangxi,China)

机构地区：[1]玉林市第一人民医院神经外科

出　　处：《西部医学》2019年第6期904-907,共4页Medical Journal of West China

基　　金：广西自然科学基金资助项目(2012GXNSFAA053112)

摘　　要：目的研究有创颅内压(ICP)监测在大面积脑梗死患者手术治疗中的应用,为最佳手术时机的选择提供理论依据.方法回顾性分析2015年6月~2017年6月于我院治疗的140例大面积脑梗死患者资料,70例采用临床症状及头颅CT/MRI判断手术时机的设为对照组,70例采用有创ICP监测判断手术时机的设为观察组.比较两组治疗疗效、美国国立卫生研究院卒中量表(NIHSS)评分、生活能力Barthel指数以及格拉斯哥昏迷(GCS)评分,并记录手术时间、住院时间、甘露醇使用情况,随访记录并发症发生情况.结果两组治疗后良好、中残、重残、植物生存、死亡病例差异具有统计学意义(P<0.05);两组治疗后Barthel指数、NIHSS评分、GCS评分差异均具有统计学意义,且治疗后观察组与对照组差异具有统计学意义(P<0.05);两组手术时间差异无统计学意义(P>0.05),观察组住院时间、甘露醇日均用量、使用时间均显著低于对照组,差异具有统计学意义(P<0.05);观察组肺部感染、电解质紊乱发生率显著低于对照组,差异具有统计学意义(P<0.05).结论有创ICP监测能够更准确判断大面积脑梗死患者的手术时机,甘露醇用量准确能有效改善预后,降低住院时间并减少并发症发生.Objective To investigate the application value of invasive intracranial pressure(ICP) monitoring in the surgical treatment of large area cerebral infarction and provide a theoretical basis for the surgical treatment. Methods The clinical data of 140 patients with large-area cerebral infarction treated in our hospital from June 2015 to June 2017 were retrospectively analyzed. 70 patients in the control group were given CT/MRI examinations, while 70 patients in the observation group were given invasive ICP monitoring. Then the therapeutic efficacy, NIHSS score, Barthel index and Glasgow Coma Scale(GCS) score were compared between the two groups. The operation time, length of hospital stay, mannitol dosage and complications during follow-up were recorded. Results The proportion of good, moderate disability, severe disability, plant survival and death among two groups had no difference(P<0.05). The Barthel index, NIHSS score, and GCS score were significant difference between groups(P<0.05). While the operation time showed no significant difference between groups(P>0.05). The length of hospital stay, the average dosage of mannitol in the observation group were significantly lower than those in the control group(P<0.05). The incidence of pulmonary infection and electrolyte disturbance in the observation group was significantly lower than that in the control group(P<0.05). Conclusion The invasive ICP monitoring is an effective way to judge the operation time and control the mannitol dosage with shorter hospital stay and fewer complications for patients with large area cerebral infarction.

关 键 词：有创ICP监测 大面积脑梗死 手术治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]