动态颅内压监测在高血压脑出血合并脑疝血肿清除术及标准大骨瓣减压术后的应用

目的研究持续动态颅内压(ICP)监测对高血压脑出血(HICH)合并脑疝患者显微血肿清除术及标准大骨瓣减压术后早期并发症的预测价值。方法对96例高血压脑出血合并脑疝患者的临床资料进行回顾分析。患者的平均出血量(85.3±12.4)mL,格拉斯哥昏迷量表(GCS)评分为(5.7±2.3)分;均行开颅显微血肿清除术及标准大骨瓣减压术,术后1~7 d行动态监测颅内压变化。根据颅内压值将患者分为轻度升高组(52例)、中度升高组(25例)和重度升高组(19例)。比较3组患者间术后早期并发症及3个月后的格拉斯哥预后量表(GOS)评分。结果颅内压不同程度升高3组患者的术后GCS评分比较显示,颅内压越低组患者的GCS评分越高(均P<0.05)。颅内压越高组患者的术后再出血、脑水肿发生率和死亡率越高(P<0.005~0.001)。颅内压越高组患者术后并发症发生的时间越短,3组患者术后并发症发生时间的差异有统计学意义(P<0.001)。而术后并发症的发生时间与同期GCS评分无明显关系,表明GCS评分对于术后并发症早期发现的效果差,不如颅内压值改变敏感。术后3个月时,3组患者的恢复良好率(GOS评分5级)和死亡率(GOS评分1级)比较,差异均有统计学意义(均P<0.001);颅内压越高组患者的预后则越差。结论颅内压动态监测可早期、灵敏地预测术后颅内压变化,积极指导术后的治疗,减少重症脑出血合并脑疝患者的术后并发症,提高手术的疗效。

Application of continuous intracranial pressure monitoring after standard decompressive craniectomy with mega-bone flap and microscopic hematoma evacuation in patients with massive cerebral hemorrhage complicated with cerebral herniation

Objective To evaluate the value of continuous dynamic monitoring of intracranial pressure(ICP)in patients with hypertensive intracerebral hemorrhage(HICH)complicated with cerebral hernia after microscopic hematoma removal and standard decompressive craniectomy with mega-bone flap to predict early postoperative complications.Methods The clinical data of 96 patients with HICH complicated with cerebral hernia were analyzed retrospectively.All patients underwent craniotomy for microscopic hematoma removal and standard decompressive craniectomy with mega-bone flap,and their ICP changes were monitored invasively and continuously for 1 to 7 days after surgery.The average blood loss during surgery for the group of patients was(85.3±12.4)mL and the mean Glasgow coma scale(GCS)score was(5.7±2.3).According to the ICP,the patients were divided into mild elevation group(52 cases),moderate elevation group(25 cases)and severe elevation group(19 cases).Early postoperative complications and Glasgow outcome scale(GOS)scores 3 months later were compared among the 3 groups.Results The comparison of GCS scores in different ICP groups showed that the lower the ICP,the higher the GCS score.The higher the ICP,the higher the postoperative rebleeding,brain edema and mortality.There was significant difference in the occurrence time of postoperative complications among different ICP groups(P<0.05).The higher the mean ICP,the shorter the time of complications.However,the occurrence time of postoperative complications was not related to the GCS score of the same period,which indicated that the early intervention effect of GCS score for early detection of complications was not as sensitive as that of ICP in the same period.3 months later,the GOS score of grade 1 death and grade 5 recovery was better,and there were statistical differences among different ICP elevated groups,suggesting that the higher the ICP,the worse the prognosis.Conclusions Based on the findings,the dynamic monitoring of ICP can early and sensitively predict postoperative complications of patients with severe cerebral hemorrhage complicated with cerebral hernia,and guide the clinical intervention actively to improve the surgery outcome.