连续动态颅内压监测对预测高血压脑出血患者预后的价值

Predicting value of continuous dynamic intracranial pressure monitoring for the patients with hypertensive cerebral hemorrhage

目的观察分析高血压脑出血患者连续动态颅内压监测对预后的预测价值。方法选取2013—01～2016—01我院神经外科收治的100例确诊为高血压脑出血的患者，采用随机数表法分为观察组和对照组，每组各50例；对照组采用传统方法，观察组采用连续动态颅内压监测，分析比较两组患者治疗前后格拉斯哥昏迷评分（GCS）及住院时间，治疗前后颅内压（ICP）、颅脑灌注压（cPP）及血肿侧与健侧ICP的差值（D值），预后情况。结果两组患者人院前的GCS评分比较差异无统计学意义（P〉0．05）；出院时观察组患者的GCS评分明显高于对照组（P〈0．05）。观察组的住院天数明显少于对照组（P〈0．05）。两组患者人院时ICP、CPP、D值比较差异无统计学意义（P〉0．05）；入院后3d复测时，观察组患者的ICP及D值明显高于对照组（P〈0．05），但CPP比较差异无统计学意义（P〉0．05）。对照组患者颅内感染率为10．00％，观察组为2．00％，两组比较差异有统计学意义（P〈0．05）；对照组的病情改善率为80．00％，明显低于观察组（96．00％，P〈0．05）；对照组的病情恶化率为30．00％，明显高于观察组（2．00％，P〈0．05）。结论连续动态颅内压监测相比传统颅内压监测能及时有效反映患者颅内压变化，为患者诊疗方案的调整节省宝贵时间，并且能极大改善预后，降低高血压脑出血患者的死亡率。

Objective To analyze the predicting value of continuous dynamic intracranial pressure monitoring for the patients with hypertensive cerebral hemorrhage. Methods A total of 100 patients admitted in our hospital from January 2013 to January 2016 with diagnosis of hypertensive cerebral hemorrhage were divided into observation group and control group by random tree table method, with 50 cases in each group; Control group using traditional methods to evaluate intracranial pressure; observation group using continuous dynamic intracranial pressure monitoring. Glasgow coma scale（GCS） before and after treatment, the length of stay, ICP values before and after the treatment, CPP value, D value and the patients prognosis were compared between the two groups. Results The GCS score on admission did not have any statistical difference between the two groups（P 〉 0.05 ） , but the GCS score in observation group was significantly lower than that in control group at discharge （ P 〈 0. 05 ）. Hospitalization days of observation group were obviously less than that of control group, and the difference between the two groups had statistical significance （P 〈 0.05）. The ICP value, CPP, D value on admission had no statistically significant difference between the groups （ P 〉 0.05 ） ; 3 days after admission, the ICP value and D value in observation group were significantly lower than those in control group （ P 〈 0.05 ） ; but the difference of CPP values had no statistical significance （ P 〉 0.05 ）. Intraeranial infection rate was 10.00% in control group, but it was 2.00% in observation group; the difference between the two groups had statistical significance （ P 〈 0.05 ）. The improvement rate in control group was 80.00%, which was significantly lower than the observation group （96.00%, P 〈 0.05）. Deterioration rate of the control group was 30.00%, which was significantly higher than the observation group （2.00%, P 〈 0.05 ）. Conclusion Compared with traditional intracranial pressure detection, dynamic intracranial pressure monitoring can timely and effectively reflect the intracranial pressure change. Therefore, it saves precious time for patients to make a diagnosis and adjust the treatment plan. This method greatly improves the prognosis, reduces mortality of hypertensive cerebral hemorrhage patients.