小脑梗死合并梗阻性脑积水开颅术后后颅窝与侧脑室内压力的相关性研究  

Study on the correlation between posterior fossa and lateral ventricular pressure after craniotomy for cerebellar infarction combined with obstructive hydrocephalus

作　　者：时传君 郭钦栋 孙守家 张源[1] 黄齐兵[1] 晏骖 Shi Chuanjun;Guo Qindong;Sun Shoujia;Zhang Yuan;Huang Qibing;Yan Can(Intensive Care Unit of Emergency Neurosurgery Department,Qilu Hospital,Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院急诊神经外科重症监护室,济南250012

出　　处：《中华神经外科杂志》2024年第5期487-491,共5页Chinese Journal of Neurosurgery

基　　金：中华国际医学交流基金会心血管多学科整合思维研究基金(2021-N-15-31)。

摘　　要：目的探讨小脑梗死合并梗阻性脑积水患者开颅术后后颅窝与侧脑室内压力的相关性,对比分析单纯监测侧脑室内压力与同时监测侧脑室和后颅窝内压力患者的预后。方法回顾性分析2018年8月至2023年3月山东大学齐鲁医院急诊神经外科行后颅窝开颅去骨瓣减压及脑室外引流术治疗的50例小脑梗死合并梗阻性脑积水患者的临床资料。术后28例患者同时进行侧脑室和后颅窝内压力监测(简称联合监测组),22例患者仅行侧脑室内压力监测(简称侧脑室监测组)。采用简单线性回归模型分析联合监测组侧脑室内压力与同一时刻后颅窝内压力的相关性。出院后6个月进行门诊或电话随访,根据格拉斯哥预后分级(GOS)分为预后不良(Ⅰ~Ⅲ级)和预后良好(Ⅳ~Ⅴ级)。比较两组患者术后7 d及出院前格拉斯哥昏迷评分(GCS)、脑室外引流管留置时长、住院时长及预后。结果联合监测组28例患者共采集颅内压数据3370次;术后侧脑室内压力[(8.53±4.48)mm Hg(1 mm Hg=0.133 kPa)]较后颅窝内压力[(13.47±4.12)mm Hg]低,差异具有统计学意义(配对t值=104.41,P<0.001);简单线性回归模型分析结果显示,侧脑室与后颅窝内压力呈正相关(R 2=0.64),线性回归公式拟合为Y=0.87 X-3.19(Y为侧脑室内压力,X为后颅窝内压力;P<0.001)。联合监测组与侧脑室监测组比较,脑室外引流管留置时长、住院时长、术后7 d及出院时GCS的差异均无统计学意义(均P>0.05)。术后6个月随访时,联合监测组预后良好19例(67.9%),预后不良9例(32.1%);侧脑室监测组预后良好14例(63.6%),预后不良8例(36.4%);两组比较,差异无统计学意义(χ^(2)=0.16,P=0.977)。结论小脑梗死合并梗阻性脑积水患者的后颅窝与侧脑室内压力存在差异,两者呈正相关;单纯基于侧脑室内压力监测与同时监测侧脑室和后颅窝压力指导术后治疗可获得相似的临床预后。Objective To explore the correlation between the posterior fossa pressure and lateral ventricular pressure in patients with cerebellar infarction and obstructive hydrocephalus after craniotomy,and to compare and analyze the outcomes of patients who undergo monitoring of intraventricular pressure and simultaneous monitoring of lateral ventricular and posterior fossa pressure.Methods A retrospective analysis was performed on 50 patients with cerebellar infarction combined with obstructive hydrocephalus who underwent posterior fossa craniotomy,decompressive craniectomy and external ventricular drainage at the Emergency Neurosurgery Department of Qilu Hospital of Shandong University from August 2018 to March 2023.According to clinical data,28 patients underwent postoperative intraventricular and posterior fossa pressure monitoring at the same time(as the joint monitoring group),and 22 patients only underwent intraventricular pressure monitoring(as the lateral ventricular pressure monitoring group).A simple linear regression model was used to analyze the correlation between intraventricular pressure in the joint monitoring group and pressure in the posterior fossa at the same time.Outpatient or telephone follow-up was conducted 6 months after discharge,and patients were divided into poor outcome(gradeⅠtoⅢ)and good outcome(gradeⅣtoⅤ)according to the Glasgow Outcome Scale(GOS).The Glasgow Coma Score(GCS),length of external ventricular drainage tube indwelling,length of hospitalization and outcomes of the two groups of patients were compared 7 days after surgery and before discharge.Results A total of 3370 intracranial pressure data were collected from^(2)8 patients in the joint monitoring group;the postoperative intraventricular pressure[8.53±4.48 mm Hg(1 mm Hg=0.133 kPa)]was lower than the pressure in the posterior fossa(13.47±4.12 mm Hg),and the difference was statistically significant(paired t value=104.41,P<0.001).The simple linear regression model analysis results showed that there was a positive correlat

关 键 词：脑梗死 颅窝 后 神经外科手术 颅内压 引流术 

分 类 号：R743.33[医药卫生—神经病学与精神病学]