脑室引流管夹闭时间对颅内压监测数值的影响

Effect of the clamping time of ventricular drainage tube on the monitoring value of intracranial pressure

目的观察脑室引流管不同夹闭时长对颅内压监测数值的影响。方法选取北京市某三级甲等医院神经外科监护室55例留置脑室外引流(EVD)并监测颅内压的患者为研究对象,以持续引流状态得到的颅内压数值为基线,读取基线数值及夹闭后1、2、3、4、5、10、15和30 min时的颅内压数值,分析不同时间点测得颅内压数值的变化。结果颅内压初次达到峰值时间多在夹闭后10 min以上,其中10~15 min 48例次(17.08%),>15~30 min 147例次(52.31%)。ICP基线数值与夹闭3、4、5、10、15、30 min的数值比较,差异有统计学意义(P<0.05);夹闭3 min以上不同时间点ICP值两两比较,夹闭3~5 min ICP数值无显著改变(P>0.05),而夹闭10 min与夹闭3 min、4 min ICP数值比较有统计学差异(P<0.05),夹闭15 min与夹闭3~5 min间ICP数值有统计学差异(P<0.05),夹闭30 min ICP数值与之前夹闭时间点均有统计学差异(P<0.05)。比较ICP基线数值与EVD夹闭后5、10、15、30 min时SBP、DBP、CPP、HR、RR、SPO2数值,夹闭后30 min时测得SBP值与ICP基线及EVD夹闭后5 min、10 min时数值差异有统计学意义(P<0.05),夹闭后30 min时测得DBP值与ICP基线、EVD夹闭后15 min时数值差异有统计学意义(P<0.05)。ICP基线CPP数值与EVD夹闭后5 min、10 min、15 min、30 min时差异均有统计学意义(P<0.05)。各时间点测得的HR、RR、SPO2数值组间比较差异无统计学意义(P>0.05)。结论临床需要一个标准用于指导医务人员为留置EVD持续引流脑脊液的患者监测ICP,通过规范操作同时规范夹闭EVD时间读取患者ICP数值指导临床操作。EVD夹闭测压的安全时段为5~10 min。

Objective To observe the effect of different clamping time of ventricular drainage tube on the monitoring value of intracranial pressure.Methods A total of 55 patients with external ventricular drainage and intracranial pressure monitoring in the Neurosurgical Care Unit of a Grade-ⅢHospital in Beijing were selected as the study subjects.The intracranial pressure values obtained during continuous drainage were taken as the base⁃line values,and the intracranial pressure values at 1,2,3,4,5,10,15 and 30 min after clamping were obtained.The changes of intracranial pressure measured at different time points were analyzed.Results Most of the initial peak time of intracranial pressure was more than 10 minutes,including 48 cases(17.08%)within 10 to 15 minutes and 147 cases(52.31%)within 15 to 30 minutes.The ICP baseline value was significantly different from the ICP baseline value for 3,4,5,10,15 and 30 min(P<0.05).Pair comparison of ICP values at different time points over 3 min showed no significant change in ICP values between 3 and 5 min(P>0.05).There were signifi⁃cant differences in ICP values between 10 min and 3,4 min(P<0.05).There was a significant difference in ICP between 15 min and 3-5 min(P<0.05).There were significant differences in ICP value between 30 min and pre⁃vious clamping time points(P<0.05).The values of SBP,DBP,CPP,HR,RR and SPO2 measured at 30 min were compared with those measured at 5,10,15 and 30 min with EVD,and the differences between SBP measured at 30 min and ICP baseline value and EVD clamping at 5 min and 10 min were statistically significant(P<0.05).The DBP value measured at 30 min was significantly different from the ICP baseline value and EVD clamping at 15 min(P<0.05).When ICP baseline value was measured,there were statistically significant differences between CPP and EVD for 5 min,10 min,15 min and 30 min(P<0.05).There was no significant difference in the values of HR,RR and SPO2 measured at different time points between those groups(P>0.05).Conclusion There is a need for a standard to guide the monitoring of ICP in patients with EVD and continuous drainage of cerebrospinal fluid.The ICP value of patients can be read through standardized operation and standardized clamping EVD time to guide clinical operation.The safe period of EVD clamping pressure measurement was between 5 and 10 min.