持续颅内压监测下高血压脑出血患者的血压控制

目的探讨颅内压（ICP）监测对高血压丘脑出血患者血压控制的意义。方法回顾性分析2011年1N9月收治的32例高血压丘脑出血患者的临床资料,其中20例行侧脑室外引流术的同时监测ICP（ICP组）,另12例单纯行侧脑室外引流术（非ICP组）。结果术后1d复查头部cT示,ICP组丘脑血肿增加量【（1．15±2．28）m1]明显少于非ICP组[（3．50±3．23）ml;P〈0．05】;住院期间ICP组平均动脉压[（79．50±4．07）mmHg]明显低于非ICP组[（87．17±2．92）mmHg;P〈0．05]。术后两组各出现脑梗死1例。结论控制性低灌注压可减少高血压丘脑出血患者血肿的增加,且并不增加脑缺血发生率;ICP监测下对高血压丘脑出血患者血压调控更加准确、安全,对穿刺后脑脊液的释放有安全指导作用;ICP监测对高血压丘脑出血患者是一种安全、有效的监测手段。     

开颅术后经硬膜下引流管测量颅内压的可行性分析

目的 探讨开颅术后经硬膜下引流管监测颅内压（ICP）的可行性与效果。方法 2020年1月至2022年8月前瞻性选择开颅手术治疗的病人56例,术中将ICP监测探头置入脑室并使用Codman颅内压监护仪连续监护1周（金标准）;同时,应用液压耦合装置经术后留置硬膜下引流管测量ICP（硬膜下法）。结果 56例金标准测得的ICP[（13.34±5.41）mmHg]与硬膜下法测得的ICP[（14.96±5.33）]无统计学差异（P>0.05）。去骨瓣减压术25例金标准测得的ICP[（13.76±5.14）mmHg]与硬膜下法测得的ICP[（14.68±4.71）mmHg]无统计学差异（P>0.05）。未去骨瓣31例金标准测得的ICP[（13.00±5.66）mmHg]与硬膜下法测得的ICP[（15.03±5.80）mmHg]无统计学差异（P>0.05）。硬膜下法测得的ICP与金标准的差值为（1.6±2.1）mmHg;两种方法测得的ICP呈明显正相关（r=0.892,P<0.001）。术后发生颅内感染1例（1.78%）、颅内少量出血1例（1.78%）。结论 与脑室ICP监测相比,开颅术后使用液压耦合装置经硬膜下引流管可以较为准确地监测ICP,方法简单、经济,易于基层医院推广应用。     

经颅多普勒对颅内感染患者颅内压和脑灌注压的预测价值

目的 探讨经颅多普勒（TCD）频谱参数对颅内感染患者颅内压（ICP）和脑灌注压（CPP）的预测价值。方法 对42例颅内感染患者进行的128次腰穿测压前行TCD检查，对TCD资料及脑脊液压力进行分析，并与对照组比较。结果 颅内感染组患者随着ICP升高，TCD表现出高阻力血流频谱，波形普遍变尖，收缩期血流（Vs）无明显变化，舒张期血流（Vd）减慢，搏动指数（PI）增大。与对照组比较血流速度明显增快。根据TCD参数及预测ICP（ICPe）及预测CPP（CPPe）的回归方程，ICPe及CPPe值与实测的ICP、CPP值呈正相关（r=0．594、0．910，均P〈0．001）。结论 TCD频谱参数可较准确预测颅内感染患者ICP、CPP的变化。     

无创颅内压监护在迟发创伤性颅内血肿中的应用

目的探讨无创颅内压（NICP）监护存迟发性创伤性颅内血肿（DTIH）临床诊治中的应用。方法应用NICP监测技术前瞻性地对86例中、重型创伤性脑损伤（TBI）患者的颅内压（ICP）进行动态监护，评价NICP监护在发现DTIH中的作用。结果86例TBI患者经CT证实有17例为DTIH，其中15例需手术治疗，发现时间为伤后6～74h，平均19．6h。监测结果显示迟发血肿侧ICP较对侧明显增高[（380±62）mmHg：（254±56）mmHg，P〈0．01]，而且明显高于69例伤后24h无DTIH患者的平均ICP[（380±62mmHg：（242±65）mmHg，P〈0．01]。16例监测到ICP增高与CT检查结果吻合（94．1％）。结论NICP监护是一种简单、无创、有效的TBI监护技术．对早期诊断DTIH可提供重要信息。     

47例脑室铸型颅内压动态监护分析

目的探讨无创颅内压(intracranial pressure,ICP)动态监测技术对脑室出血铸型患者救治的指导作用。方法分别采用无创颅内压监护仪和简易脑室外引流管测压装置,对47例脑室铸型患者进行ICP动态监测观察ICP与患者生命体征、临床症状和预后关系,分析其对脑室外引流及其他降颅压治疗的指导作用。依据术后颅内压监测分为3组,A组15~20mmHg(n=12);B组21~40mmHg(n=8);C组40mmHg(n=27)。结果 ICP35mmHg,且持续不降,病死率高;脑室外引流对持续ICP增高者有显著的治疗作用。ICP值与患者预后呈显著负相关。结论无创颅内压动态监测技术监测能有效缓解颅内压监测盲区,适时给予脑室外引流使得有效及时给予降低颅内压,减少并发症,降低病死率;无创ICP动态监护安全有效、可控性强,是临床医师对脑室出血铸型患者病情变化作出判断的重要参考依据。     

颅脑创伤患者颅内压相关参数与预后关系的研究

目的 探讨颅脑创伤患者的颅内压（ICP）相关参数与预后的关系.方法 回顾性纳入2016年11月至2017年10月上海交通大学医学院附属仁济医院神经外科重症监护室收治的50例闭合性颅脑创伤患者.患者均行有创颅内压、动脉压监测,采用Neumatic DCR数据采集系统监测ICP相关参数.根据出院时格拉斯哥预后分级（GOS）将患者分为预后不良组（GOS Ⅰ、Ⅱ级）20例和预后相对良好组（GOSⅢ-Ⅴ级）30例.比较两组患者的ICP相关参数,采用受试者工作特征曲线（ROC）评估相关参数的预测能力.结果 （1）与预后相对良好组比较,预后不良组的ICP[（26.2±13.4）mmHg对比（14.0±5.6） mmHg]、压力反应指数（PRx,0.48±0.21对比0.12 ±0.08）及ICP波幅与动脉压波幅的相关系数（IAAC,中位数为0.14对比0.01）均升高,平均脑灌注压[CPP,（48.9±19.9） mmHg对比（81.1±6.9）mmHg]降低,差异均有统计学意义（均P〈0.01）;ICP波幅与ICP的相关系数（RAP）差异无统计学意义（P〉0.05）.多因素二元Logistic回归分析显示,ICP（OR=2.187,95％ CI：1.079-4.431,P=0.031）、PRx（OR=21.608,95％ CI：3.012-155.014,P=0.002）是预后的独立影响因素.（2）预后不良组在20 mmHg及22 mmHg阈值上的ICP“剂量”（DICP20、DICP22）均高于预后相对良好组（均P〈0.05）.DICP20的ROC曲线下面积为0.70,DICP22为0.71.预后不良组在0.25及0.05阈值上的PRx“剂量”（D PRx0.25、DPRx0.05）均高于预后相对良好组;DPRx0.25的曲线下面积为0.97,DPRx0.05为0.96.结论 ICP和PRx为颅脑创伤患者不良预后的独立危险因素;ICP“剂量”和PRx“剂量”均可作为判断患者死亡及植物状态预后的参数,且PRx“剂量”的准确性更高.     

经颅多普勒与闪光视觉诱发电位预测颅内感染患者颅内压的临床应用价值

目的探讨经颅多普勒(TCD)与闪光视觉诱发电位(FVEP)预测颅内感染患者颅内压(ICP)的临床应用价值。方法对65例颅内感染患者(颅内感染组)及30例非颅内感染患者(对照组)腰穿测压前分别行TCD及FVEP检查,分析ICP与TCD血流动力学参数、FVEP各波潜伏期的相关性;比较两种方法预测ICP的准确性。结果颅内感染组共行182例次腰椎穿刺检查,ICP正常42例次,轻度增高80例次,中度增高60例次;发现脑血管痉挛(CVS)84例次。与对照组比较,颅内感染组ICP明显增高;随着ICP增高,TCD的舒张期血流(Vd)减慢,博动指数(PI)增加;FVEP的P2、N2、P3、N3潜伏期延迟越明显;ICP与PI及N2潜伏期相关性最大(r=0.612,r=0.708,均P=0.000)。当预测ICP值(ICPe)与ICP差值<5 mmHg时,ICPeFVEP的准确性(78.6%)明显优于ICPeTCD(65.9%)(P<0.01);患者伴有CVS时,ICPeFVEP的准确性明显高于ICPeTCD(P=0.000)。结论 TCD及FVEP均可用于临床无创预测ICP,但ICPeFVEP准确性更高。     

有创颅内压监测靶向管控在重型颅脑损伤患者围术期应用价值分析

目的探讨有创颅内压（ICP）监测靶向管控在重型颅脑损伤（sTBI）患者围术期的应用价值。 方法选取千佛山医院神经外科诊疗中心自2017年1月至2021年12月收治住院的168例sTBI患者的临床资料进行回顾性队列研究，将应用ICP监测的sTBI患者设为试验组（88例），同期未应用ICP监测的sTBI患者为对照组（80例）。对2组患者甘露醇的应用情况、术后并发症、出院时GOS评分、住院费用、住院时间及神经外科重症监护病房（NSICU）治疗时长进行对比分析。 结果相较于对照组，试验组患者甘露醇的使用时长及总量均显著降低，住院及NSICU治疗时长显著减少，而预后良好率更高，差异均具有统计学意义（P<0.05）；2组患者的颅内感染率和非计划再次手术率比较，差异无统计学意义（P>0.05）。 结论有创ICP监测下的靶向管控对于sTBI患者可以动态监测患者ICP变化，及时评估病情，更有效地控制甘露醇的使用，显著降低住院时长，提高患者预后，降低颅内感染率。     

一种微型压力传感器监测颅内压的临床评价

对于严重脑外伤,颅内出血和脑肿瘤,颅内压升高是一种常见的并发症。有效地处理颅内压升高可以降低死亡率。测量颅内压有许多方法,有用脑室(或硬膜下置引流管或用液体连接于外接传感传感器的蛛网膜下腔栓子测压的,有用纤维光导设备测压的,但是,记录颅内压的理想方法还有待于改进,因目前的颅内压监测设备均有某种局限。作者对一种新型微型压力传感器进行了临床评价。 作者用30个微型压力传感器测量了25名病人(1～3管/人)。其将一微型压力传感器置于一脑室引流管内,距引流管顶端1厘米进行测压,同时,脑室引流管外接一传感器进行测压,脑室引流管最长放     

有创颅内压监测技术的研究进展

颅内压(ICP)监测和ICP指导下的治疗仍然是当代神经危重症治疗的基石。ICP监测可连续反应病人ICP的变化,在对颅内伤情和脑肿胀严重程度的判断及治疗选择、预后评估等方面都有重要的指导意义。有创ICP监测技术在临床上应用达数十年之久,为ICP监测提供了大量的实践经验和数据,使得有创测压方法日趋成熟。本文就有创ICP监测技术的研究进展进行综述。     

Cerebral Vascular Changes During Acute Intracranial Pressure Drop

Neurocritical Care - This study applied a new external ventricular catheter, which allows intracranial pressure (ICP) monitoring and cerebral spinal fluid (CSF) drainage simultaneously, to study...     

2058例重型颅脑创伤颅内压动态监护分析

目的 探讨颅内压(intraeranial pressure,ICP)持续动态监护对重型颅脑创伤(severe traumatic brain injury,sTBI)救治的指导意义.方法 分别采用脑窜内及脑实质内ICP监护法,对2058例sTBI患者进行ICP持续动态监护,观察ICP与患者生命体征、临床表现和预后的关系,分析其对脑室外引流及其他降颅压治疗的指导作用.结果 ICP持续动态监护末并发严重颅内感染及出血,脑室外引流对持续ICP增高者有显著的治疗作用,ICP值与患者预后呈显著负相关.结论 ICP持续动态临护安全、易行,其有助于sTBI患者病情变化的及时、正确判断,能为临床医生制定治疗方案及预后病人评估提供重要的参考依据.     

Intraventricular catheter placement by electromagnetic navigation safely applied in a paediatric major head injury patient

INTRODUCTION: In the management of severe head injuries, the use of intraventricular catheters for intracranial pressure (ICP) monitoring and the option of cerebrospinal fluid drainage is gold standard. In children and adolescents, the insertion of a cannula in a compressed ventricle in case of elevated intracranial pressure is difficult; therefore, a pressure sensor is placed more often intraparenchymal as an alternative option. DISCUSSION: In cases of persistent elevated ICP despite maximal brain pressure management, the use of an intraventricular monitoring device with the possibility of cerebrospinal fluid drainage is favourable. We present the method of intracranial catheter placement by means of an electromagnetic navigation technique.     

Third ventriculostomy through the lamina terminalis for intracranial pressure monitoring after aneurysm surgery: technical note

OBJECTIVE: A new ventriculostomy technique through the lamina terminalis is described. This technique is applied mainly during aneurysm surgery at the acute stage. METHOD: Thirteen patients were operated on intracranial aneurysms and, during the procedure, had the lamina terminalis fenestrated. A ventricular catheter was inserted into the third ventricule, left in place and connected to an external drainage system for further intracranial pressure (ICP) monitoring and/or cerebrospinal fluid (CSF) drainage. RESULTS: ICP readings and CSF drainage were obtained in all cases. No complication was recorded. CONCLUSION: Third ventriculostomy through the lamina terminalis is a simple and easy technique that can be used as an alternative to conventional ventriculostomy. This procedure can be indicated in cases where the ventricule is not reached by means of another technique, and when the decision to perform ventriculostomy is made at the end of aneurysm surgery.     

Comparison of ventricular drainage in poor grade patients after intracranial hemorrhage

OBJECTIVES: The selection of patients and treatment criteria for acute hydrocephalus and intracranial pressure (ICP) after intracranial hemorrhage remains unclear. In general neurosurgical practice, there is a tendency to use external ventricular drainage (EVD) for the patients. This study was undertaken to analyse the complications and efficiency of the different treatment modalities.METHODS: The effects, complications and outcome of ventricular drainage on high ICP and hydrocephalus were analysed retrospectively in 109 patients with intracranial hemorrhage. All the patients were assessed using the Glasgow Coma Scale, computed tomography and ICP monitoring. We excluded patients over the GCS of 8. All patients underwent a procedure for ICP monitoring plus ventricular cerebrospinal fluid (CSF) drainage. Sixty-one patients were managed with one (single) EVD system; 12 patients needed two EVD systems consecutively, while 23 patients underwent an EVD procedure followed by permanent ventriculoperitoneal (VP) shunt insertion. Thirteen patients were treated only by VP shunt for ventricular drainage. The infection rate and outcome 9 months after hemorrhage were analysed.RESULTS: The infection rates were 8.1% in the one-EVD group, 33.3% in the two-EVD group (one EVD versus two EVD, p<0.05), 8.6% in the EVD-VP group and 7.7% in the VP shunt group. The mortality rates were 73.7% in the one-EVD group, 83.8% in the two-EVD group, 47.8% (p<0.05) in the EVD-VP group and 53.8% (p<0.01) in the VP shunt group.DISCUSSION: This study indicates that single and short-term use of EVD and/or early VP shunting are associated with a low risk of infection. Furthermore, early VP shunting may protect the brain from the irregular control of intracranial hypertension and may allow more time for resolution of CSF circulation and significantly lowers the mortality rates.     

颅内压监测下侧脑室外引流治疗丘脑出血破入脑室

目的探讨颅内压监测下侧脑室外引流治疗高血压性丘脑出血破入脑室的疗效。方法收集60例高血压性丘脑出血破入脑室患者的临床资料,无颅内压监测组32例,未应用颅内压监测,颅内压监测组28例,加用颅内压持续监测,比较两组的再出血率、并发症发生率及总体预后。结果颅内压监测组与无颅内压监测组相比,再出血率及并发症发生率明显降低,死亡率降低,恢复良好率提高,均有显著性差异。结论颅内压监测下侧脑室外引流治疗高血压性丘脑出血破入脑室可以更加直观、更准确地了解患者颅内压力的变化情况,根据颅内压控制引流速度、合理应用脱水剂及控制血压、保证有效满意的脑灌注压,进而降低了再出血率、减少了并发症,改善了患者的预后,安全性更高、疗效更好。     

Infratentorial intracranial pressure monitoring in neurosurgical intensive care unit

Monitoring intracranial pressure (ICP) is an important element of neurosurgical critical care that is used primarily as an indicator of adequate cerebral perfusion. Such monitoring is usually done with intraparenchymal, subdural or intraventricular pressure sensor connected to a pressure transducer system. In the past, multiple studies have shown that there are certain pressure gradients between various intracranial compartments, especially if there is some focal intracranial pathological process. Several clinical and laboratory studies measured ICP inside the posterior fossa by placing the sensor into the cisterna magna or the cerebellopontine angle. None of them, however, monitored direct intraparenchymal pressure in the posterior fossa. Such measurement may be a more sensitive way to assess focal swelling, ischemia and tissue perfusion in the posterior fossa structures. We simultaneously monitored supratentorial ICP using an external ventricular drain placed in the lateral ventricle and infratentorial ICP with an intraparenchymal sensor inserted into the cerebellum. We subsequently analyzed data from five patients with different posterior fossa pathology each of which had simultaneous supra- and infratentorial ICP recordings for up to five days. We found difference in ICP between the infratentorial and supratentorial compartments and this difference changed over time. In this article, we discuss feasibility and safety of simultaneous infra- and supratentorial ICP monitoring in patients with the posterior fossa pathology.     

颅内压监护在急性中型颅脑损伤患者治疗中的意义

目的研究原发性急性中型颅脑损伤患者行颅内压(ICP)监测对临床诊治的意义。方法71例伤后24h内入院的原发性急性中型颅脑损伤患者,入院时均行头部CT检查无手术指征,将其随机分为ICP监护治疗组(35例):入院后即采用目前国际上通用的脑室内穿刺置管法行ICP持续监护,用美国产Marquette监护仪进行4 ~ 7 d连续监测;常规治疗组(36例):进行包括脱水、止血、防治上消化道出血等治疗,监测生命征、意识的改变及血、尿等常规和生化指标,必要时对治疗方案作出调整。结果ICP监护治疗组出现3例ICP>40 mmHg或入院后ICP很快进行性增高,行CT检查发现迟发性颅内血肿或原位血肿增大、中线明显移位,即手术治疗。术后1例重残,1例中残,1例轻残;另有5例患者ICP监护中发现达中度增高(20 ~ 40 mmHg),CT检查提示仅为脑水肿加重,不具手术指征,经调整脱水药剂量,间断开放脑室外引流后病情平稳好转。结论中型颅脑损伤伤后病情不稳定,行ICP监测能及早发现病情变化,可降低致残率和死亡率,有效提高疗效,改善预后。