快速颅内压监测联合血肿穿刺在严重高血压脑出血患者术前应用的临床研究  

Clinical research of rapid intracranial pressure monitoring combined with hematoma puncture before surgery in patients with severe hypertensive intracerebral hemorrhage

作　　者：王佳[1] 邓永兵[1] 胡晞[1] 邹胜伟[1] Wang Jia;Deng Yongbing;Hu Xi;Zou Shengwei(Department of Neurosurgery,Chongqing Emergency Medical Center(Affiliated Central Hospital of Chongqing University),Chongqing 400014,China)

机构地区：[1]重庆市急救医疗中心(重庆大学附属中心医院)神经外科,400014

出　　处：《中华神经创伤外科电子杂志》2020年第2期100-104,共5页Chinese Journal Of Neurotraumatic Surgery：Electronic Edition

基　　金：重庆市教委科学技术研究项目(KJQN201800124)。

摘　　要：目的探讨快速颅内压(ICP)监测联合颅内血肿穿刺在严重高血压脑出血(HICH)患者术前应用的临床意义。方法选取重庆市急救医疗中心神经外科自2016年1月至2019年6月收治的90例严重HICH患者,按随机数字表法分为YL-1型针快速颅内血肿穿刺+开颅血肿清除及去骨瓣减压组(对照组1),单纯开颅血肿清除及去骨瓣减压组(对照组2),ICP探头快速置入ICP监测+YL-1型针快速颅内血肿穿刺+开颅血肿清除及去骨瓣减压组(试验组),每组病例30例。比较3组患者开颅准备时间,各时间点ICP、GCS评分,神经外科重症监护室(NICU)总住院时间以及6个月后的预后情况。结果3组患者的开颅准备时间比较,差异无统计学意义(P>0.05);NICU住院时间比较,试验组病例最短,对照组1次之,对照组2最长,差异有统计学意义(P<0.05)。3组患者术后当天及术后1 d的ICP值比较,差异无统计学意义(P>0.05);术后3、5 d,试验组<对照组1<对照组2,差异有统计学意义(P<0.05);3组患者术后1 d的GCS评分比较,差异无统计学意义(P>0.05),术后1周、1个月,试验组>对照组1>对照组2。术后6个月随访,试验组的GOS评分优于对照组1和对照组2,差异有统计学意义(F=10.361,P=0.001)。结论快速ICP监测联合颅内血肿穿刺在严重HICH患者术前应用能有效降低患者术后ICP,缩短NICU住院时间,改善患者预后,且不延长开颅准备时间,值得在临床治疗中推广应用。Objective To explore the clinical significance of rapid intracranial pressure(ICP)monitoring combined with intracranial hematoma puncture in patients with severe hypertensive intracerebral hemorrhage(HICH).Methods Ninety severe HICH patients selected from Department of Neurosurgery,Chongqing Emergency Medical Center from January 2016 to June 2019 were randomly divided into the YL-1 type needle rapid intracranial hematoma puncture combined with hematoma removal(control group 1),large decompression craniotomy group(control group 2)and ICP monitoring by rapid ICP penetration+YL-1 type needle rapid intracranial hematoma puncture+hematoma removal and large decompression craniotomy group(experimental group),30 patients for each group.The craniotomy preparation time,ICP and GCS scores at each time point,the total hospitalization time of neurosurgical intensive care unit(NICU)and the prognosis after 6 months were compared among 3 groups.Results There was no significant difference in preparation time of craniotomy among 3 groups(P>0.05),the time of hospitalization of NICU was the shortest in the experimental group,the second in the control group and the longest in the control group(P<0.05).There was no significant difference in ICP among 3 groups on the same day and the 1st day after operation(P>0.05),on the 3rd and 5th day after operation,the difference was statistically significant(P<0.05),and the experimental group<control group 1<controlgroup 2.There was no significant difference in GCS score amongn 3 groups on the 1st day after operation(P>0.05),1 week and 1 month after operation,the difference was statistically significant(P<0.05),and the experimental group>control group 2>control group 1.After 6 months follow-up,the GOS score of the experimental group was better than that of the control group 1 and 2,the difference was statistically significant(F=10.361,P=0.001).Conclusion Preoperative application of rapid ICP monitoring combined with intracranial hematoma puncture used for HICH can effectively decrease postoperati

关 键 词：高血压脑出血 颅内压 脑灌注压 颅内血肿穿刺 开颅去骨瓣减压 

分 类 号：R651.1[医药卫生—外科学]