高血压脑出血无创颅内压及脑灌注压监测临床研究

Monitoring noninvasive intracranial pressure and cerebral perfusion pressure in treatment of patients with hypertensive intracerebral hemorrhage

目的探讨高血压脑出血手术前后监测无创颅内压（NICP）、脑灌注压（CPP）变化的临床意义。方法收集解放军第474医院神经外科自2008年6月至2010年5月收治的120例高血压脑出血手术患者，按照随机数字表法分为监测组及非监测组。监测组手术前后采用中国重庆名希医疗器诫公司MICP．1A型闪光视觉诱发电位NICP监测仪行NICP和CPP监测，非监测组不行监测。比较2组患者不同治疗效果。结果监测组手术前后除10例NICP压力〈26．6mmHg，CPP〉124．3mmHg外，其余50例均有不同程度NICP增高与CPP降低。术后GOS评分结果显示监测组患者恢复良好31例（51．7％），轻残20例（33．3％），重残5例（8-3％1，死亡4例（6．7％）；非监测组恢复良好23例（38-3％），轻残18例（30．0％），重残10例（16．7％），死亡9例（15．0％）。监测组疗效明显优于非监测组，差异有统计学意义俨〈0．05）。结论对高血压脑出血患者手术前后施行NICP、CPP监测是指导临床用药、降低并发症和病死率的有效措施，具有重要临床应用价值。

Objective To evaluate clinical significance of monitoring noninvasive intracranial pressure （NICP） and cerebral perfusion pressure （CPP） in treatment of patients with hypertensive intracerebral hemorrhage. Methods This clinical randomized controlled trial enrolled 120 patients with hypertensive intracerebral hemorrhage who had sought medical treatment in our department from June 2008 through May 2010. They were randomized equally into a monitoring group where NICP and CPP were continuously monitored before and after operation and a non-monitoring group where no monitoring of NICP and CPP was performed. Results In the monitoring group, increased NICP and decreased CPP were shown in 50 patients and only 10 patients were shown with normal NICP （〈 26.6mmHg） and CPP （〉 124.3 mm Hg）. The abnormal NICP and CPP continuously monitored were treated with specific interventions like further operation or medication. In the non-monitoring group, patients received only conventional treatments. According to the Glasgow Outcome Scale （GOS）, 31 patients （51.7%） had good recovery, 20 （33.3%） were moderately disabled, 5 （8.3%） severely disabled and 4 （6.7%） dead in the monitoring group while 23 （38.3%） patients had good recovery, 18 （30.0%） were moderately disabled, 10 （16.7%） severely disabled and 9 （15.0%） dead in the non-monitoring group. The outcomes of the monitoring group were significantly better than those of the non-monitoring group （P〈0.05）. Conclusion Continuous monitoring of NICP and CPP before and after operation should be performed in the treatment of patients with hypertensive intracerebral hemorrhage because it is helpful for clinical medication and reducing complications and mortality as well.