眶上外侧入路联合颅内压监测治疗破裂颅内动脉瘤效果评价

Evaluation of the superior lateral orbital approach combined with intracranial pressure monitoring in the treatment of ruptured intracranial aneurysms

目的探讨眶上外侧入路联合动态颅内压监测在破裂颅内动脉瘤患者治疗中的临床价值。方法对2020-01—2022-12扬州大学附属医院收治的72例破裂颅内动脉瘤患者的临床资料进行回顾性分析,入院后均行眶上外侧入路动脉瘤夹闭,术中置入颅内压监测探头,术后骨瓣复位,术后1~7 d进行动态监测颅内压变化。根据颅内压(ICP)值将患者分为轻度升高组(41例)、中度升高组(26例)和重度升高组(5例)。分析3组基本临床资料、术后并发症发生情况以及术后3个月患者GOS评分。结果3组患者入院时的临床资料无统计学差异,具有可比性。3组患者术后GCS评分有统计学差异(P<0.05),根据ICP监测结果,每组患者在术后第1、3、7天的颅内压比较有统计学差异(P<0.05)。3种并发症发生时间具有统计学差异,脑水肿的发生时间较早(P<0.001)。脑水肿发生时的颅内压较高(P=0.041),GCS评分无统计学差异(P=0.063)。术后并发症如肺部感染、脑梗死发生率依次升高,差异有统计学意义(P<0.05),但术后并发症的发生时间与同期GCS评分无统计学差异。术后3个月随访,患者恢复良好率(GOS 5分)和病死率(GOS 1分)有统计学差异(P<0.05)。结论颅内动脉瘤破裂出血患者使用眶上外侧入路联合动态颅内压监测能够及时较早了解颅内压变化,有助于早期预测术后病情,从而指导术后治疗,一定程度上能改善患者预后,降低并发症和病死率。

Objective To investigate the clinical value of supraorbital lateral approach combined with dynamic intracranial pressure monitoring in the treatment of patients with ruptured intracranial aneurysms.Methods The clinical data of 72 patients with ruptured intracranial aneurysms from January 2020 to December 2022 in the Affiliated Hospital of Yangzhou University were retrospectively analyzed.The patients were divided into mildly elevated(41 cases),moderately elevated(26 cases)and severely elevated(5 cases)groups according to their intracranial pressure(ICP)values.The basic clinical data,the occurrence of postoperative complications and the patients’GOS scores at 3 months after surgery were analysed in the three groups.Results There were no statistical differences in the clinical data of the three groups at the time of admission and they were comparable.There was a significant difference in the postoperative GCS scores of the three groups(P<0.05),and we found significant differences in the intracranial pressure monitoring results of patients in each group at the 1st,3rd and 7th day postoperative(P<0.05)according to ICP monitoring results.We found a significant difference in the time of onset of the three complications,with cerebral oedema occurring earlier(P<0.001).Intracranial pressure values at the onset of the three complications were also statistically significant,with higher intracranial pressure at the onset of cerebral oedema(P=0.041).There was no significant difference in GCS scores at the onset of the three complications(P=0.063).The incidence of postoperative complications such as pulmonary infection and cerebral infarction were sequentially higher,with a statistically significant difference(P<0.05),but there was no significant difference between the time of onset of postoperative complications and the GCS score at the same time.When follow-up was performed 3 months after surgery,there was a significant difference in the rate of good recovery(GOS 5 score)and mortality(GOS 1 score)(P<0.05).Conclusion The use of the supraorbital lateral approach combined with dynamic intracranial pressure monitoring in patients with ruptured intracranial aneurysm can provide timely and early information on intracranial pressure changes,which can help to predict the patient’s postoperative condition and thus guide the postoperative treatment,and to a certain extent improve the patient’s prognosis and reduce the incidence of complications and death.