29例脑积水患儿围手术期颅内压监测及其临床意义分析

Perioperative monitoring of intracranial pressure in 29 children with hydrocephalus and its clinical significance

目的探讨脑积水患儿不同术式治疗后颅内压（intracranial pressure,ICP）的改变及其临床意义。方法回顾性分析我科2011年1月至2012年12月住院手术治疗的29例脑积水患儿围手术期的ICP变化,其中分流手术14例,脑室镜下三脑室底造瘘术（endoscopic third ventriculostomy,ETV）15例。使用脑实质型ICP探头在手术前后连续监测ICP的变化,监测时间72～168 h。结果与术前比较,两组术后ICP均有明显下降（P〈0.05）。术后连续监测显示两手术组ICP变化明显不同,分流手术组ICP呈持续下降趋势,ETV组ICP术后迅速回升,再呈缓慢下降趋势。可调压管分流组术后24 h内回升到接近术前的水平,此后120 h内逐渐下降至调压阀设定的压力水平。脑室镜手术组术后24～48 h内可出现一过性高颅压,其中肿瘤继发脑积水亚组较先天性脑积水亚组明显,持续时间更长。结论 ICP监测能准确反映脑积水患儿围手术期颅压变化,术后持续监测有助于准确判断ETV的手术效果。

Objective To investigate the changes of intracranial pressure （ICP） and its clinical significance in the children with hydrocephalus who treated by different surgeries. Methods Clinical data of 29 children with hydrocephalus receiving surgical treatment in our department of neurosurgery from January 2011 to December 2012 were collected in this study and retrospectively analyzed. Fourteen of them underwent ventriculo-peritoneal shunt surgery, and the other 15 received endoscopic third ventriculostomy （ETV）. The ICP values in perioperative period were continuously monitored in all patients by brain parenchymatype ICP probe before and after surgery （ ranging from 72 to 168 h）, and recorded for its clinical significance. Results ICP value were significantly declined postoperatively when compared with the preoperative value in all the patients （P 〈0.05 ）. Results of postoperative continuous monitoring indicated that the changes of postoperative ICP were significantly different between the 2 surgery groups. ICP showed a continuous declining trend in the shunt surgery group, however the pressure rise rapidly after surgery and then decreased slowly in the ETV group. ICP of programmable valve subgroup returned to almost preoperative level within 24 h, and gradually decreased to the level of the setting pressure within 120 h thereafter. There was a transient high intracranial pressure in ETV group within 24 to 48 h postoperatively, and this process was significant and longer lasting in tumors secondary to hydrocephalus subgroup than in congenital hydrocephalus subgroup. Conclusion ICP monitoring can accurately reflect intracranial pressure change in the children with hydrocephalus, and postoperative continuous monitoring may help to accurately determine the surgical effect of ETV.