高血压脑出血术后颅内压监测的临床意义

Clinical performance of invasive intracranial pressure monitoring technology in evaluating patients with hypertensive cerebral hemorrhage after surgery

探讨高血压性脑出血患者行开颅清除血肿及去骨瓣减压术后,对术后患者进行持续有创动态监测颅内压(ICP)的临床意义。对本院神经外科收治的120例高血压性脑出血患者的临床资料进行回顾性分析,患者均行开颅清除血肿及开颅去骨瓣减压术,术后接受1~7 d持续动态颅内压监测。依据术后颅内压上升情况,将患者分为正常和轻度升高组,中度升高组,重度升高组。比较3组患者基本资料,术后颅内压监测期间临床信息和并发症,术后6个月预后。结果表明:120例高血压性脑出血术后患者,正常和轻度颅内压升高组87例,中度颅内压升高组22例,重度颅内压升高组11例,3组患者临床基本资料差异无显著性(P>0.05)。患者术后颅内压升高情况和GCS评分呈负相关(r=-0.633,P<0.01);3组并发症发生率逐渐增加,分别为11.5%,36.4%和63.6%,差异有显著性(χ^2=20.04,P<0.001);术后6个月预后优良率逐渐降低,分别为84.0%,45.5%和27.3%,差异显著(χ^2=24.54,P<0.001)。从而得出结论:持续有创颅内压监测应用于高血压性脑出血术后,能早期预测患者术后病情、并发症情况和预后,有助于及时采取客观准确的临床治疗方案,进而改善患者预后。

To investigate the clinical performance of invasive intracranial pressure monitoring technology in evaluating patients with hypertensive cerebral hemorrhage after craniotomy with removal of hematoma and decompressive craniectomy.Clinical data of 120 patients with hypertensive cerebral hemorrhage undergoing craniotomy with removal of hematoma and decompressive craniectomy from December 2015 to December 2018 were retrospectively analyzed.Patients were treated and collected by the Department of Neurosurgery,The Second People's Hospital of Lu'an.The patients were divided into three groups according to intracranial pressure monitoring result after surgery.Basic information,incidence rate of complications during monitoring and prognosis at six months after operation were compared.A total of 120 patients fall into three groups:normal and mild increased intracranial pressure group(N=87),moderate increased intracranial pressure group(N=22)and severe increased intracranial pressure group(N=11).The basic information shows no statistical difference between three groups(P>0.05).Glasgow coma scale gradually decreases with increasing intracranial pressure and they are significantly correlated(r=-0.633,P<0.01).Incidence rate of complications during monitoring gradually increases with increasing intracranial pressure(11.5%,36.4%and 63.6%,respectively),and the difference is significant(χ^2=20.04,P<0.001);prognosis fineness rate at six months after operation gradually decreases with increasing intracranial pressure(84.0%,45.5%and 27.3%,respectively),and the difference is significant(χ^2=24.54,P<0.001).Invasive intracranial pressure monitoring can be used to predict the postoperative condition,complications and prognosis of patients with hypertensive intracerebral hemorrhage.It can help to guide clinical treatment and improve prognosis.