国内脑出血颅内压监测值参考标准的初步探索

Tentative exploration of domestic reference standards of intracranial pressure in patients with intracerebral hemorrhage

目的由于脑出血患者较缺乏颅内压(ICP)系统的研究,目前推荐的脑出血ICP管理主要来自于TBI治疗的经验,尚缺乏直接证据。本研究旨在探讨ICP与脑出血结果的相关性,并分析临界值ICP>20mmHg(依据TBI资料)是否适用于脑出血。方法前瞻性持续纳入在2010-01-01-2015-06-31入住神经科的昏迷脑出血且均进行了ICP监控的患者。发病3个月转归采用mRS评分。多变量逻辑回归分析探讨ICP与预后相关的危险因素。结果最后纳入98例患者分析。ICP均值(OR1.2,CI 1.08~1.45,P=0.003),ICP最大值(OR1.06,1.01~1.1,P=0.015),ICP方差(OR 1.3,1.03~1.73,P=0.03),以及ICP值>20mmHg的相对频率(OR1.1,1.02~1.15,P=0.008)都与随访3个月时病死率显著相关。ICP值>20mmHg的相对频率(OR1.1,1.02~1.15,P=0.008)也与随访3个月时病死率显著相关。结论 ICP可变性及ICP值>20 mmHg的频率与脑出血后病死率和不良结局呈独立相关。将来应开展前瞻性研究进一步确定我们的结论,同时验证ICP的参考阈值。

Objective As there were few studies on intracranial pressure （ICP） in patients with severe intracerebral hemor- rhage （ICH） and at present the recommendation of ICP management mainly came from TBI therapeutic experiences,our study aimed at exploring the correlation of ICP with ICH and analyzing whether the critical value of ICP （〉20mmHg） was appropriate for ICH or not. Methods Our prospective study continuously recruited comatose ICP patients who were monitored in the depart- ment of neurology. The prognosis was assessed by mRS scores. Multivariate logistic regression was used to identify the risk factors of ICP and prognosis. Results Eventually,there were 98 patients selected in our study. The mean value of ICP （OR= 1.2,95 % CI：1. 08 to 1.45,P=0. 003）,the maximum value of ICP （OR=1. 06,95% CI：1. 01 to 1.1,P=0. 015）,the value of ICP square deviation （OR = 1.3,95 CI ： 1.03 to 1.73,P = 0.03） and the relative frequency of ICP value〉20mmHg （OR = 1.1,95 % CI ： 1.02 to 1.15,P =0. 008） were correlated with the fatality rate during the three-month follow-up period. Conclusion The variabili- ty of ICP and the frequency of ICP value 〉20mmHg have independent correlations with fatality rate and adverse outcome. And more prospective studies should be researched to confirm our conclusion and verify the critical value of ICP.