脑组织氧饱和度监测联合持续颅内压监测在脑出血患者手术中的应用  

Application of oxygen saturation monitoring of brain tissue combined with continuous intracranial pressure monitoring in the operation of patients with cerebral hemorrhage

作　　者：王忠 张晓军 包金岗 韩志桐 王俊青 吴日乐 张义松 赵卫平 张瑞剑 Wang Zhong;Zhang Xiaojun;Bao Jin′gang;Han Zhitong;Wang Junqing;Wu Rile;Zhang Yisong;Zhao Weiping;Zhang Ruijian(Department of Neurosurgery,Inner Mongolia People′s Hospital,Hohhot 010017,China)

机构地区：[1]内蒙古自治区人民医院神经外科,呼和浩特010017

出　　处：《中国综合临床》2021年第5期406-410,共5页Clinical Medicine of China

基　　金：内蒙古自治区卫生和计划生育委员会资助项目 (201701009);内蒙古自治区科技厅资助项目 (201502107);内蒙古自治区关键技术攻关计划项目 (2019GG051)。

摘　　要：目的探讨持续颅内压(continuous intracranial pressure,ICP)监测联合局部脑氧饱和度(regional cerebral oxygen saturation,rScO2)监测在高血压脑出血患者小骨窗血肿清除术前后的应用及对患者预后的影响。方法选取2018年4月至2020年10月内蒙古自治区人民医院神经外科神经重症病房收治的37例幕上高血压脑出血患者的临床资料进行回顾性分析,患者行小骨窗脑内血肿清除术,采用ICP监测及近红外光谱技术( near infrared spectroscopy technology,NIRS)监测手术前后颅内压及rScO2浓度,对手术前后颅内压及rScO2的变化进行分析。患者随访至术后6个月,以格拉斯哥预后评分(glasgow outcome score,GOS)判断,规定GOS评分>3分者为预后良好,归入预后良好组(21例),≤3分者为预后较差归入预后较差组(16例),分别比较两组患者术前术后颅内压及rScO2变化情况。结果术后高血压脑出血患者颅内压[(15.80±6.70) mmHg]较术前[(20.40±5.80) mmHg]下降,差异有统计学意义(t=3.226,P=0.002);术后rScO2[(62.31±3.85)%]较术前[(59.73±3.13)%]明显上升,差异有统计学意义(t=3.171,P=0.002)。术后预后良好组患者颅内压[(6.53±2.21) mmHg]较预后不良组[(4.24±2.30) mmHg]下降更明显,两组rScO2均有不同程度提高,但在预后良好组术后其rScO2提高程度(3.99±2.34)%明显高于预后不良组(2.32±2.25)%,术后6个月预后良好组与预后不良组间术前术后颅内压及rScO2差值比较,差异有统计学意义(t=3.090、2.176;P=0.004、0.036)。结论小骨窗脑内血肿清除术能明显降低脑出血患者的颅内压,提高rScO2,术前、术后颅内压及rScO2的变化水平对患者的预后判断有潜在价值。Objective To investigate the application of continuous intracranial pressure(ICP)combined with regional cerebral oxygen saturation(rScO2)monitoring in patients with hypertensive intracerebral hemorrhage before and after operation of the removal hematoma through small bone window and the effect on the prognosis of patients.Methods The clinical data of 37 patients with supratentorial hypertensive intracerebral hemorrhage admitted to the neurosurgical intensive care unit of the people′s Hospital of Inner Mongolia Autonomous Region from April 2018 to October 2020 were retrospectively analyzed.ICP monitoring and near infrared spectroscopy(NIRS)were used to monitor the intracranial pressure and rScO2 concentration before and after the operation,and the changes of intracranial pressure and rScO2 before and after the operation were analyzed.According to Glasgow Outcome Score(GOS),patients with GOS score>3 were classified as good prognosis group(21 cases),and those with GOS score≤3 were classified as poor prognosis group(16 cases).Results The postoperative intracranial pressure((15.80±6.70)mmHg)of patientswith hypertensive intracerebral hemorrhage was lower than that before operation((20.40±5.80)mmHg),and the difference was statistically significant(t=3.226,P=0.002).The postoperative rScO2((62.31±3.85)%)of patientswith hypertensive intracerebral hemorrhage was higher than that before operation((59.73±3.13)%),and the difference was statistically significant(t=3.171,P=0.002).The decrease of intracranial pressure in patients with good prognosis((6.53±2.21)mmHg)was more obvious than that in patients with poor prognosis((4.24±2.30)mmHg).The concentration of rScO2 increased in both groups.But in the group with good prognosis,the rScO2 increased((3.99±2.34)%)was significantly higher than that in poor prognosis group((2.32±2.25)%).Six months after operation,there were significant differences in preoperative and postoperative intracranial pressure and rScO2 between good prognosis group and poor prognosis group,and the

关 键 词：高血压脑出血 颅内压监测 近红外光谱技术 局部脑氧饱和度 预后 

分 类 号：R651.12[医药卫生—外科学]