持续颅内压和脑组织氧分压联合监测在高血压性脑出血手术前后的应用

Combined continuous monitoring of intracranial pressure and brain tissue oxygen partial pressure before and after operation for hypertensive intracerebral hemorrhage

目的探讨持续颅内压(ICP)监测联合脑组织氧分压(PbtO_(2))监测在高血压性脑出血(HICH)患者小骨窗血肿清除术前后的应用及对患者预后的影响。方法回顾性分析2018年9月至2020年10月内蒙古自治区人民医院神经外科神经重症病房收治的幕上HICH行小骨窗脑内血肿清除术27例患者的临床资料。患者均于术前植入ICP及PbtO_(2)监测探头,行持续ICP及PbtO_(2)监测至术后7 d,并根据监测结果实施目标导向治疗方法。随访至术后6个月,将格拉斯哥预后评分(GOS)>3分者归入预后良好组(n=18),≤3分者归入预后不良组(n=9),分析比较两组患者术前术后ICP及PbtO_(2)变化情况。结果经小骨窗血肿清除术和ICP及PbtO_(2)监测下实施目标导向治疗,HICH 27例患者术后ICP水平较术前显著下降[(15.80±6.70)mm Hg vs(20.40±5.80)mm Hg,P<0.01];PbtO_(2)水平较术前显著上升[(22.15±5.25)mm Hg vs(17.43±4.34)mm Hg,P<0.01]。按术后6个月GOS评分分组后回顾性分析发现,术后6个月与预后不良组比较,预后良好组ICP的术后与术前差值负值绝对值更大(P<0.01),提示ICP下降更显著;预后良好组PbtO_(2)的术后与术前差值正值更大(P<0.05),提示PbtO_(2)升高更显著。结论在HICH患者小骨窗脑内血肿清除术前后实施持续ICP及PbtO_(2)监测,可有效指导术中术后的相关治疗,促进ICP水平的降低、PbtO_(2)水平的提高。

Objective To investigate the application of continuous monitoring of intracranial pressure(ICP)with partial pressure of brain tissue oxygen(PbtO_(2))in patients with hypertensive intracerebral hemorrhage(HICH)before and after hematoma removal with small bone window and the effect on the prognosis of patients.Methods A retrospective analysis was performed on 27 supratentorial HICH patients treated with hematoma removal through small bone window from September 2018 to October 2020.All patients underwent continuous ICP and PbtO_(2) monitoring before and 7 days after operation,the goal-directed therapy was implemented according to the monitoring results.After 6 months of followed-up after operation,the patients with Glasgow prognosis score(GOS)more than 3 were classified into good prognosis group(n=18),and those with GOS less than or equal to 3 were classified into poor prognosis group(n=9).The changes of ICP and PbtO_(2) before and after operation were analyzed and compared between two groups.Results After treatment,ICP level[(15.80±6.70)mm Hg vs(20.40±5.80)mm Hg,P<0.01]decreased significantly,and PbtO_(2) level[(22.15±5.25)mm Hg vs(17.43±4.34)mm Hg,P<0.01]significantly increased compared with those before operation.According to the GOS score at 6 months after operation,the retrospective analysis found that compared with the poor prognosis group,the negative absolute value of the postoperative and preoperative difference of ICP in the good prognosis group was greater(P<0.01),suggesting that the ICP decreased more significantly;the positive value of the postoperative and preoperative difference of PbtO_(2) in the good prognosis group was greater(P<0.05),suggesting that the PbtO_(2) increased more significantly.Conclusion In HICH patients with removal of intracerebral hematoma through small bone window,continuous monitoring of ICP combined with PbtO_(2) can effectively guide the relevant treatment during and after operation,thus promoting the decrease of ICP level and the increase of PbtO_(2) level.