小骨窗开颅血肿清除术结合持续颅内压监测对脑出血患者疗效及预后的影响分析

The effects and prognosis of intracranial pressure monitoring combined with small bone window craniotomy hematoma removal in patients with cerebral hemorrhage

目的:探讨小骨窗开颅血肿清除术结合颅内压监测对脑出血患者疗效及预后的影响。方法:选取2017年4月至2018年12月江苏省溧阳市人民医院收治的76例脑出血患者,两组均实施小骨窗开颅血肿清除术,根据是否使用持续颅内压监测分为观察组(n=34)和对照组(n=42)。观察组术中、术后行持续颅内压监测,对照组常规围术期干预治疗。比较两组手术时间、术中出血量、血肿清除率、术后甘露醇用量及使用时间,评估患者手术疗效,记录两组围术期手术相关不良反应,随访6个月记录远期疗效。结果:两组手术时间、术中出血量、血肿清除率比较,差异均无统计学意义(P>0.05)。观察组术后甘露醇使用时间短于对照组,用量少于对照组(P<0.05)。术后4周,两组治疗总有效率比较,差异无统计学意义(P>0.05)。两组再出血、肺部感染、颅内感染、肾损害发生率比较,差异无统计学意义(P>0.05)。观察组电解质紊乱及总并发症发生率均低于对照组(P<0.05)。随访6个月后,观察组改良Rankin量表(mRS)得分优于对照组(P<0.05)。结论:脑出血围术期应用持续颅内压监测效果良好,在降低并发症、改善用药和远期疗效方面均有积极意义。

Objective:To explore the effects and prognosis of intracranial pressure monitoring combined with small bone window craniotomy hematoma removal in patients with cerebral hemorrhage.Methods:A total of 76 patients with cerebral hemorrhage surgery in our hospital from April 2017 and December 2018 were selected.All patients were given small bone window craniotomy hematoma removal,and according to whether received continuous intracranial pressure monitoring,the patients were divided into an observation group(n=34)and a control group(n=42).The patients in the observation group were given intracranial pressure monitoring during and after surgery,and those in the control group were given routine perioperative intervention.The operation time,intraoperative blood loss,hematoma clearance rate,dosage and time of postoperative mannitol use were compared between the two groups.The surgical efficacy was evaluated,and the perioperative surgery-related adverse reactions were recorded.At 6 months of follow-up,the long-term efficacy was recorded.Results:There were no significant differences in the surgery time,intraoperative blood loss and hematoma clearance rate between the two groups(P>0.05).The use time and dosage of postoperative mannitol in the observation group were lower than those in the control group(P<0.05).At 4 weeks after surgery,there was no significant difference in the total effective rate between the two groups(P>0.05).There were no significant differences in the incidence of rebleeding,pulmonary infection,intracranial infection and renal damage between the two groups(P>0.05),and the incidence of electrolyte disturbance and total incidence rate of complications in observation group were lower(P<0.05).After 6 months of follow-up,the modified Rankin scale(mRS)score in the observation group was better than that in the control group(P<0.05).Conclusion:Continuous intracranial pressure monitoring during perioperative period cerebral hemorrhage surgery was effective in reducing complications and improving medication and had long-term efficacy.