神经内镜下手术清除脑室内血肿后液压耦合监测颅内压的疗效分析  

Analysis of the Efficacy of Hydraulic Coupling for Monitoring Intracranial Pressure after Neuroendoscopic Surgical Removal of Intracerebroventricular Hematoma

作　　者：虞凯迪 宋黄成 龚辉 顾旭辉 袁斌斌 刘婷婷[1] 王耀娟 虞聪 YU Kai-di;SONG Huang-cheng;GONG Hui(Department of Neu-rosurgery,Haimen Hospital Affiliated to Nantong University,Nantong,Jiangsu,226100,China)

机构地区：[1]南通大学附属海门医院神经外科,江苏南通226100

出　　处：《黑龙江医学》2023年第7期780-784,共5页Heilongjiang Medical Journal

摘　　要：目的:探讨神经内镜辅助手术清除脑室内血肿后采用液压耦合技术监测颅内压的疗效及优势。方法:选取2014年1月—2021年5月南通大学附属海门医院收治的60例脑室内出血患者作为研究对象,根据是否术中清除血肿分为神经内镜下清除脑室内血肿+外引流(内镜组30例)和单纯侧脑室穿刺+外引流(单纯组30例)。分别统计两组患者入院时的基本信息(年龄、性别、出血量、出血部位)、术后采用液压耦合监测颅内压数据、术后脑室外引流时间、术后并发症、术后脑积水和3个月时日常,生活能力(ADL)评定量表评分,观察内镜组和单纯外引流组短期和长期预后指标。结果:两组患者术前基本情况比较,差异无统计学意义(P>0.05);术后内镜组颅内压均值明显低于单纯组,差异有统计学意义(t=17.43、14.95、40.00、26.20、22.07、20.50、45.40,P<0.05);术后30 d两组患者神经功能缺损评分(NIHSS)较术前明显降低,且与单纯组相比,内镜组更低,差异有统计学意义(t=21.50,P<0.05)。术后内镜组患者血肿量少于术前,差异有统计学意义(P<0.05);短期预后结果显示,内镜组的血肿清除率高于单纯引流组,差异有统计学意义(P<0.05);内镜组引流时间缩短,差异有统计学意义(P<0.05);内镜组术后并发症(肺部感染、颅内感染、脑积水)发生率低,差异有统计学意义(P<0.05),长期预后结果显示,内镜组患者预后良好率明显高于单纯引流组,差异有统计学意义(χ^(2)=9.304,P<0.05)。结论:应用神经内镜清除脑室内血肿+外引流治疗脑室内出血,具有微创、血肿清除率高、并发症少和改善患者预后的优点,同时采用液压耦合技术监测颅内压具有准确、方便、价廉的特点,是一种安全有效的外科治疗方法。Objective:To investigate the efficacy and advantages of using hydraulic coupling technique to monitor intracranial pressure after neuroendoscopy-assisted surgery to remove intracerebroventricular hematoma.Methods:60 patients with intraventricular hemorrhage admitted to the hospital from January 2014 to May 2021 were selected for the study,and were divided into neuroendoscopic removal of intraventricular hematoma+external drainage group(endoscopic group,30 cases)and simple lateral ventricular puncture+ex⁃ternal drainage group(simple group 30 cases)according to whether the hematoma was removed intraoperatively.The basic in⁃formation(age,sex,bleeding volume,bleeding site)at the time of admission,postoperative intracranial pressure monitoring data using hydraulic coupling,postoperative external ventricular drainage time,postoperative complications,postoperative hydro⁃cephalus and 3-month ADL score were counted for both groups.The short-term and long-term prognostic indicators were observed in the endoscopic and external drainage-only groups.Results:There was no statistically significant difference between the two groups when comparing the basic preoperative conditions of the patients(P>0.05).The mean value of intracranial pressure was sig⁃nificantly lower in the endoscopic group than in the simple group after surgery,and the difference was statistically significant(t=17.43,14.95,40.00,26.20,22.07,20.50,45.40,P<0.05).The neurological deficit(NIHSS)score was significantly lower in both groups at 30 d postoperatively compared with the preoperative period and was lower in the endoscopic group compared with the simple group,with a statistically significant difference(t=21.50,P<0.05).The amount of hematoma was less in the postoperative endoscopic group than in the preoperative group,and the difference was statistically significant(P<0.05).The short-term prog⁃nostic results showed that the hematoma clearance rate was higher in the endoscopic group than in the drainage only group,with a sta⁃tistically significant

关 键 词：神经内镜 脑室内出血 微创手术 液压耦合 颅内压 疗效 

分 类 号：R651[医药卫生—外科学]