近红外光谱技术在高血压脑出血术中监测运用的探讨

Discussion on monitoring and application of near infrared spectroscopy in hypertensive cerebral hemorrhage

目的探讨近红外光谱技术(NIRs)在术前、术中、术后对高血压脑出血病人颅内压(ICP)、脑灌注压(CPP)和生命体征的影响。方法将高血压脑出血病人20例按健侧及患侧术前、术中、术后监测病人ICP、CPP、脑组织血氧饱和度(rScO_2)和生命体征变化,并进行相关性分析。结果随着手术的进程,患者的CPP值逐渐升高,ICP值逐渐降低,组间差异具有统计学意义(P<0.05)。患侧术前、术中、术后两两比较显示,患侧术前、术中、术后患者的ICP较健侧降低(P<0.05),ICP在术中、术后亦均低于术前(P<0.05);术后病人CPP高于健侧(P<0.05)。术前、术中、术后病人的rScO_2、脉搏血氧饱和度、心率、收缩压、舒张压、平均动脉压和体温差异均无统计学意义(P>0.05)。术前、术中、术后高血压脑出血患者rScO_2水平与CPP呈负相关(P<0.05),与ICP、平均动脉压呈正相关关系(P<0.05)。结论 NIRs在高血压脑出血病人术前、术中、术后监测可及时获得出血的情况,有助于临床早期诊断和治疗。

Objective To investigate the effects of near-infrared spectroscopy on intracranial pressure(ICP),cerebral perfusion pressure(CPP)and vital signs in patients with hypertensive intracerebral hemorrhage before,during and after surgery. Methods Twenty patients with hypertensive intracerebral hemorrhage were monitored for ICP,CPP,brain tissue oxygen saturation(rScO2)and vital signs before and during operation and after operation. Correlation analysis was performed. Results With the progress of the operation,the CPP value of the patients gradually increased,and the ICP value decreased gradually. The difference between the groups was statistically significant(P<0.05). Preoperative,intraoperative,and postoperative comparisons showed that the ICP of the affected side was lower than that of the healthy side before,during,and after surgery(P<0.05). ICP was lower than that during surgery and postoperatively. Before(P<0.05);the postoperative CPP was higher than the healthy side(P<0.05).There were no significant differences in rScO2,pulse oximetry,heart rate,systolic blood pressure,diastolic blood pressure,mean arterial pressure and body temperature between preoperative,intraoperative and postoperative patients(P>0.05). Preoperative,intraoperative,postoperative,rScO2 in patients with hypertensive cerebral hemorrhage was negatively correlated with CPP(P<0.05),and positively correlated with ICP and mean arterial pressure(P<0.05). Conclusion Near-infrared spectroscopy can timely obtain bleeding in patients with hypertensive intracerebral hemorrhage before,during and after surgery,which is helpful for early diagnosis and treatment.