脑出血微创血肿清除术中的无创脑水肿动态监护

Cerebral edema monitoring by non-invasive and dynamical method in intracerebral hemorrhage with microresecting drain and aspiration hematom

目的观察脑出血患者保守治疗或微创血肿清除术治疗前后无创脑水肿动态监护仪综合扰动系数的变化,并探讨微创血肿清除手术对脑出血患者脑水肿的影响以及无创脑水肿动态监护仪监测对脑出血治疗的指导作用.方法将20例高血压性脑出血患者随机分为2组,微创血肿清除手术组(微创组):10例脑出血患者于入院6～24 h内接受简易立体定向微创血肿清除术治疗;对照组:10例脑出血患者接受内科保守治疗,所有病例均于入院后1、3、5、7 d采用无创脑水肿动态监护仪动态检测综合扰动系数.结果无论是对照组还是微创组入院后即刻检查均是患侧综合扰动系数低于健侧,随着病程推移对照组出现患侧扰动系数升高并超过健侧,3 d时达到高峰,并持续7 d以上;随着病程推移微创组出现3 d时患侧高于健侧,5 d时两侧接近,7 d时两侧基本正常;病程第3、5、7 d时2组综合扰动系数比较差异有显著性意义(P＜0.001).结论脑出血患者综合扰动系数呈不对称性改变,且随病程推移呈现动态变化,并反映了水肿形成过程,微创血肿清除术能有效清除血肿,可显著性改善脑出血后的脑水肿形成,无创脑水肿动态监护仪可动态评估患者脑水肿演变过程,对再出血的诊断及治疗有一定的指导意义.

Objective To observe the change of comprehensive agitating coefficient in the intracerebral hemorrhage （ICH） patients monitoring by non-invasive cerebral edema and dynamical method, who have accepted the conservative therapy and microresecting drain and aspiration hematom respectively and to find out the effect of microresecting drain and aspiration hematom on cerebral edema in patients with ICH, and the guiding role of non-invasive dynamical brain edema monitor in ICH treatment. Methods Twenty patients with hypertensive ICH were divided into two groups randomly. In microresecting drain and aspiration hematom group （microresecting group） .. ten patients accepted the stereo-orientation microresecting drain and aspiration hematom during 6 to 24 hours after onset; and in control group, ten patients accepted the conservative therapy. The change of comprehensive agitating coefficient in the 20 patients was detected by non-invasive dynami cal brain edema monitor at days 1, 3, 5 and 7 from ICH onset. Results The comprehensive agitating coefficient in focus side was lower than the unaffected side in both groups at the time of admission. In control group the comprehensive agitating coefficient in focus side which reached its peak in the third day and continued for more than 7 days rose and became higher than the unaffected side. However, in the microresecting group the coefficient in the focus side was higher than the unaffected side in the third day, and then became approximately equal at day 5 and basically normal at day 7. The comprehensive agitating coefficients were significantly different in both groups at day 3, 5, 7 （P〈0.001）. Conclusions The comprehensive agitating coefficient showed the asymmetric change in the ICH and took on the dynamical change, which reflects the edema formation course. The microresecting drain and aspiration hematom can clear the hematoma effectively and reduce the formation of cerebral edema significantly after ICH. Cerebral edema monitoring by non-invasive and dynamical method can evaluate the course of cerebral edema, and have a guiding role to the diagnosis and therapy of the recurrent hemorrhage to some degree.