监测脑室及腰大池压力梯度的临床意义

The value of monitoring pressure gradient of cerebral ventricle and lumbar cistern

目的:探讨脑室及腰大池压力差异的临床意义。方法:选择2008年1月至2012年12月本院本科30例因各种原因致蛛网膜下腔及脑室出血患者早期行脑室及腰大池持续引流,并监测脑室及腰大池压力的变化。结果:30例患者中,有2例因腰大池过度引流诱发了脑疝(2/30,6.67%),其中l例为小脑幕切迹疝,1例为慢性枕骨大孔疝,经夹闭腰大池引流管,开放脑室引流后脑疝得到纠正,病情好转,无死亡病例。结论:动态监测脑室及腰大池压力,缓慢匀速行脑脊液引流,能避免压力差的出现及脑疝发生,是一种有效的预防与监测手段,微侵袭、创伤小、安全性大。

Objective：To investigate the clinical significance of monitoring the pressure gradient of cerebral ventricle and lumbar cistern. Methods： We recruited 30 patients with idiopathic subdural and ventricular hemorrhage from the department of neurosurgery, Tangxia Hospital and Affiliated Nanfang Hospital of Southern Medical between January 2008 and December 2012. All subjects were treated with cerebral ventricle and lumbar cistern continuous drainage and subjected to monitoring of the changes in pressure gradient. Results： Of 30 patients in the study, 2 （ 2/30,6.67% ） had cerebral hernia owing to excessive lumbar drainage, of whom a respective single case had transtentorial herniation and chronic transforamen magna herniation. The latter was recovered following shutting off the lumbar drainage and implementation of lateral ventricle drainage. No death toll was reported. Conclusion： Characterized by effectiveness for prevention and monitoring, minimized injury and high safety, dynamic monitoring of the pressure gradient of cerebral ventricle and lumbar cistern in combination with cerebrospinal fluid drainage in a slow and steady manner may help prevent the incidence of a dramatic pressure gradient and onset of cerebral hernia.