脑肿瘤围手术期治疗中颅内压监测的临床意义  

Clinical significance of intracranial pressure monitoring during perioperative phases of surgery for brain tumors

作　　者：张俊锋[1] 吴涛[1] 丁志斌 钟海[1] 邢武君 ZHANG Jun-feng;WU Tao;DING Zhi-bin;ZHONG Hai;XING Wu-jun(The First Department of Neurology,The First Affiliated Hospital of Xi'an Medical College,Xi'an 710077,China)

机构地区：[1]西安医学院第一附属医院神经外一科,西安710077

出　　处：《中国肿瘤临床与康复》2020年第10期1166-1169,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨幕上良恶性脑肿瘤患者围手术期治疗中颅内压监测(ICP)的临床意义。方法选取2017年1月至2019年1月间西安医学院第一附属医院收治的120例幕上良恶性脑肿瘤患者,均行脑肿瘤手术治疗,围手术期均行ICP监测,统计颅内压升高率及并发症发生率,评估预后。结果术后6h,各类型患者颅内压水平与术前比较均降低,差异均有统计学意义(均P<0.05)。术后48h和72h,胶质瘤Ⅰ~Ⅳ级患者颅内压恢复,与术前比较无升高,差异无统计学意义(P>0.05);脑膜瘤Ⅰ~Ⅱ级患者颅内压均高于术前,差异均有统计学意义(均P<0.05)。术后72h,患者颅内压升高率为38.3%,其中胶质瘤Ⅳ级为58.3%,脑膜瘤Ⅱ级为47.6%,高于胶质瘤Ⅰ级的10.5%和胶质瘤Ⅱ级的16.7%,差异均有统计学意义(均P<0.05)。颅内压升高患者并发症发生率为73.9%,高于对照组的20.3%,差异有统计学意义(P<0.05)。120例患者出院3个月格拉斯哥预后评分,1级0例,2级10例,3级18例,4级61例,5级31例,良好率76.7%(92例)。结论幕上良恶性脑肿瘤患者术后围手术期行颅内压监测,可评估患者病情严重程度,及时且持续发现术后颅内压升高,为调整治疗方案提供依据,利于预后。Objective To explore the clinical significance of intracranial pressure monitoring(ICP) during perioperative phases of surgery for benign and malignant brain tumors Methods A total of 120 patients with benign and malignant brain tumors treated at The First Affiliated Hospital of Xi’an Medical College from January 2017 to December 2019 were selected.All patients underwent surgery for brain tumor,and ICP was performed during the perioperative period.The rate of increased intracranial pressure and the incidence of complications were calculated and the prognosis was assessed.Results The levels of intracranial pressure of various types were significantly reduced in both groups at 6 h after the operation,which was significantly different from that before the operation(all P < 0.05).Intracranial pressure recovered in patients with grade Ⅰto Ⅱ meningioma at 48 h and 72 h after the operation and no increase was found compared with before operation(P > 0.05).The rate of increased intracranial pressure was 38.3% at 72 h after operation.It was 58.3% in patients with grade Ⅳ glioma,47.62% in patients with grade Ⅱ meningioma,which was higher than 10.5% of patients with grade Ⅰ glioma and 16.6% of patients with grade Ⅱ glioma(all P < 0.05).The incidence of complications was 73.9% in patients with increased intracranial pressure,which was significantly higher than 20.3% of the control group(P < 0.05).At 3 months after discharge,no one was discovered to have Glasgow outcome scale(GOS) score of 1.GOS score of 2 was found in 10 patients,GOS of 3 was found in 18 patients,GOS of 4 was found in 61 patients and GOS of 5 was found in 31 patients.The rate of good prognosis was 75.49%.Conclusion Surgical monitoring of intracranial pressure can assess the severity of disease and promptly and continuously detect the increase in intracranial pressure after surgery in patients with benign and malignant brain tumors in the postoperative period,which will provide evidence for adjusting the therapies.

关 键 词：幕上良恶性脑肿瘤 围手术期 颅内压监测 颅内压 并发症 预后 

分 类 号：R739.41[医药卫生—肿瘤]