动态颅内压监测在高血压性脑出血患者术后临床应用价值  

Clinical application value of dynamic intracranial pressure monitoring in patients with hypertensive intracerebral hemorrhage after surgery

作　　者：余万[1] 张勇[1] 葛玉元[1] YU Wan;ZHANG Yong;GE Yuyuan(Department of Neurosurgery,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210028,CHINA)

机构地区：[1]南京中医药大学附属中西医结合医院神经外科,江苏210028

出　　处：《江苏医药》2022年第9期891-894,共4页Jiangsu Medical Journal

基　　金：江苏省干部保健科研课题(BJ21029);江苏省中医药研究院青年科学研究项目(QNKXYJ202110)。

摘　　要：目的 探讨动态颅内压(ICP)监测在高血压性脑出血(HICH)患者术后的临床应用价值。方法 63例HICH患者行显微镜下血肿清除和去骨瓣减压手术。术中植入ICP探头,术后1~7 d进行连续动态ICP监测。根据ICP值,将患者分为正常ICP和轻度ICP升高组(A组,30例)、中度ICP升高组(B组,20例)和重度ICP升高组(C组,13例)。分析三组基本临床资料、手术前后GCS评分、术后并发症发生情况以及术后6个月患者预后。结果 三组手术前后GCS评分以及术后电解质紊乱、肺部感染、脑水肿、脑梗死和再出血发生率差异均有统计学意义(P<0.05)。与A组相比,C组术前GCS评分较低,术后电解质紊乱、肺部感染、脑水肿、脑梗死和再出血发生率较高(P<0.05)。A、B、C组术后GCS评分和术后6个月预后良好率依次降低(P<0.05),而术后6个月死亡率依次升高(P<0.05)。结论 动态ICP监测能早期预测HICH患者术后病情,从而积极指导治疗,在一定程度上降低并发症和死亡发生率,改善患者预后。Objective To investigate the clinical application value of dynamic intracranial pressure(ICP)monitoring in the patients with hypertensive intracerebral hemorrhage(HICH)after operation.Methods The hematoma removal and decompressive craniectomy were performed in 63patients with HICH and ICP probe was inserted during surgery.The dynamic ICP monitoring was performed in 1-7days after operation.According to the value of ICP,the patients were divided into three groups of A(with normal or mild elevated ICP,30cases),B(with moderate elevated ICP,20cases)and C(with severe elevated ICP,13cases).The basic clinical data,GCS scores before and after operation,incidence of postoperative complications and prognosis after 6months were recorded in three groups.Results There were significantly statistical differences in the GCS scores before and after operation and incidences of electrolyte disturbance,pulmonary infection,cerebral edema,cerebral infarction and rebleeding among groups of A,B and C(P<0.05).Compared with group A,the GCS score before operation was lower,while the incidences of electrolyte disturbance,pulmonary infection,cerebral edema,cerebral infarction and rebleeding were higher in group C(P<0.05).The GCS score after operation and good prognosis rate after 6months were decreased in an order of group A>group B>group C(P<0.05),while the mortality after 6months was increased in an order of group A<group B<group C(P<0.05).Conclusion Dynamic ICP monitoring could early predict the postoperative illness of the patients with HICH,actively guide the treatment,partly reduce the incidence of complications and death and improve the prognosis.

关 键 词：高血压性脑出血 颅内压 

分 类 号：R743[医药卫生—神经病学与精神病学]