颅内压监测在治疗非脑疝高血压脑出血中的应用及疗效分析

Application and efficacy of intracranial pressure monitoring in the treatment of hypertensive intracerebral hemorrhage with non-cerebral hernia

目的探讨颅内压(ICP)监测对非脑疝高血压脑出血患者手术方式选择的指导价值及术后疗效分析。方法选取新疆医科大学第一附属医院神经外科中心自2018年2月至10月治疗的73例非脑疝高血压脑出血患者,根据术前是否行脑内ICP监护仪探头置入术将其分为监护组(37例)和对照组(36例)。监护组根据ICP值结合患者术前CT选择手术方式,术后制定甘露醇用法用量;对照组仅根据患者临床表现及术前CT决定手术方式,术后经验性使用甘露醇。比较2组患者的手术方式、术后并发症的发生率及预后。结果监护组患者术后甘露醇使用总剂量低于对照组,住院时间短于对照组,差异均有统计学意义(P<0.05)。监护组患者术后并发胃肠道出血、肺部感染、深静脉血栓、气管切开、二次手术去骨瓣的发生率为21.6%,低于对照组(55.6%);监护组术后6个月日常生活能力等级为Ⅰ~Ⅱ级的患者概率(81.08%)高于对照组(55.56%),差异均具有统计学意义(P<0.05)。结论术前对非脑疝高血压脑出血患者先行ICP监测,能客观指导手术方式的选择,对减少术后并发症、避免因术后脑水肿而激进性去骨瓣手术有意义,对患者术后加速康复和提高长期生活质量有很大帮助。

Objective To explore the guiding value of intracranial pressure(ICP)monitoring in the choice of surgical methods for patients with hypertensive intracerebral hemorrhage with non-cerebral hernia and to analyze the postoperative efficacy.Methods A total of 73 patients with hypertensive intracerebral hemorrhage and non-cerebral hernia treated in the Neurosurgery Center of the First Affiliated Hospital of Xinjiang Medical University from 2018 February to October were selected and divided into monitoring group(37 cases)and control group(36 cases)according to whether they underwent ICP monitor probe implantation before surgery.The monitoring group selected the operation method according to the ICP value combined with the preoperative CT,and determined the usage and dosage of mannitol after the operation.The control group only decided the operation method according to the patients'clinical manifestations and preoperative CT,and used mannitol empirically after surgery.The operative methods,postoperative complications and prognosis of the two groups were compared.Results The total postoperative dose of mannitol in the monitoring group was significantly lower than that in the control group,and the length of hospitaization was significantly shorter than that of the control group(P<0.05).The total incidence of postoperative complications including gastrointestinal bleeding,pulmonary infection,deep vein thrombosis,tracheotomy,and bone flap removal in the monitoring group was 21.6%,which was significantly lower than that in the control group(55.6%),The probability of patients with activities of daily living gradeⅠ-Ⅱin the monitoring group(81.08%)was significantly higher than that in the control group(55.56%),the difference was statistically significant(P<0.05).Conclusion Pre-operation ICP monitoring for non-cerebral hernia patients with hypertensive intracerebral hemorrhage can objectively guide the choice of surgical methods,which is of significance in reducing postoperative complications and avoiding radical osteotomy due to postoperative cerebral edema,and is of great help in accelerating postoperative rehabilitation and improving long-term quality of life.