切换至 "中华医学电子期刊资源库"
高级检索
中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2020, Vol. 06 ›› Issue (02) : 100 -104. doi: 10.3877/cma.j.issn.2095-9141.2020.02.008

所属专题： 文献；

临床研究

快速颅内压监测联合血肿穿刺在严重高血压脑出血患者术前应用的临床研究
王佳1, 邓永兵1,†(), 胡晞1, 邹胜伟1   
  1. 1. 400014　重庆市急救医疗中心（重庆大学附属中心医院）神经外科
  • 收稿日期:2019-12-15 出版日期:2020-04-15
  • 通信作者: 邓永兵
  • 基金资助:
    重庆市教委科学技术研究项目(KJQN201800124)

Clinical research of rapid intracranial pressure monitoring combined with hematoma puncture before surgery in patients with severe hypertensive intracerebral hemorrhage

Jia Wang1, Yongbing Deng1,†(), Xi Hu1, Shengwei Zou1   

  1. 1. Department of Neurosurgery, Chongqing Emergency Medical Center (Affiliated Central Hospital of Chongqing University), Chongqing 400014, China
  • Received:2019-12-15 Published:2020-04-15
  • Corresponding author: Yongbing Deng
  • About author:
    Corresponding author: Deng Yongbing, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

王佳, 邓永兵, 胡晞, 邹胜伟. 快速颅内压监测联合血肿穿刺在严重高血压脑出血患者术前应用的临床研究[J]. 中华神经创伤外科电子杂志, 2020, 06(02): 100-104.

Jia Wang, Yongbing Deng, Xi Hu, Shengwei Zou. Clinical research of rapid intracranial pressure monitoring combined with hematoma puncture before surgery in patients with severe hypertensive intracerebral hemorrhage[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2020, 06(02): 100-104.

目的

探讨快速颅内压（ICP）监测联合颅内血肿穿刺在严重高血压脑出血（HICH）患者术前应用的临床意义。

方法

选取重庆市急救医疗中心神经外科自2016年1月至2019年6月收治的90例严重HICH患者，按随机数字表法分为YL-1型针快速颅内血肿穿刺+开颅血肿清除及去骨瓣减压组（对照组1），单纯开颅血肿清除及去骨瓣减压组（对照组2），ICP探头快速置入ICP监测+YL-1型针快速颅内血肿穿刺+开颅血肿清除及去骨瓣减压组（试验组），每组病例30例。比较3组患者开颅准备时间，各时间点ICP、GCS评分，神经外科重症监护室（NICU）总住院时间以及6个月后的预后情况。

结果

3组患者的开颅准备时间比较，差异无统计学意义（P>0.05）；NICU住院时间比较，试验组病例最短，对照组1次之，对照组2最长，差异有统计学意义（P<0.05）。3组患者术后当天及术后1 d的ICP值比较，差异无统计学意义（P>0.05）；术后3、5 d，试验组<对照组1<对照组2，差异有统计学意义（P<0.05）；3组患者术后1 d的GCS评分比较，差异无统计学意义（P>0.05），术后1周、1个月，试验组>对照组1>对照组2。术后6个月随访，试验组的GOS评分优于对照组1和对照组2，差异有统计学意义（F=10.361，P=0.001）。

结论

快速ICP监测联合颅内血肿穿刺在严重HICH患者术前应用能有效降低患者术后ICP，缩短NICU住院时间，改善患者预后，且不延长开颅准备时间，值得在临床治疗中推广应用。

关键词: 高血压脑出血, 颅内压, 脑灌注压, 颅内血肿穿刺, 开颅去骨瓣减压
Objective

To explore the clinical significance of rapid intracranial pressure (ICP) monitoring combined with intracranial hematoma puncture in patients with severe hypertensive intracerebral hemorrhage (HICH).

Methods

Ninety severe HICH patients selected from Department of Neurosurgery, Chongqing Emergency Medical Center from January 2016 to June 2019 were randomly divided into the YL-1 type needle rapid intracranial hematoma puncture combined with hematoma removal (control group 1), large decompression craniotomy group (control group 2) and ICP monitoring by rapid ICP penetration+ YL-1 type needle rapid intracranial hematoma puncture+ hematoma removal and large decompression craniotomy group (experimental group), 30 patients for each group. The craniotomy preparation time, ICP and GCS scores at each time point, the total hospitalization time of neurosurgical intensive care unit (NICU) and the prognosis after 6 months were compared among 3 groups.

Results

There was no significant difference in preparation time of craniotomy among 3 groups (P>0.05), the time of hospitalization of NICU was the shortest in the experimental group, the second in the control group and the longest in the control group (P<0.05). There was no significant difference in ICP among 3 groups on the same day and the 1st day after operation (P>0.05), on the 3rd and 5th day after operation, the difference was statistically significant (P<0.05), and the experimental group<control group 1<control group 2. There was no significant difference in GCS score amongn 3 groups on the 1st day after operation (P>0.05), 1 week and 1 month after operation, the difference was statistically significant (P<0.05), and the experimental group>control group 2>control group 1. After 6 months follow-up, the GOS score of the experimental group was better than that of the control group 1 and 2, the difference was statistically significant (F=10.361, P=0.001).

Conclusion

Preoperative application of rapid ICP monitoring combined with intracranial hematoma puncture used for HICH can effectively decrease postoperative ICP and NICU length of stay, improve outcome, without extending preparation time of craniotomy, it is worthy of further clinical treatment promotion.

Key words: Hypertensive intracerebral hemorrhage, Intracranial pressure, Cerebral perfusion pressure, Puncture of intracranial hematoma, Decompressive craniectomy
表1 3组患者的一般情况比较
组别 例数 男/女 年龄（岁） GCS（分） 血肿量（mL）
对照组1 30 17/13 59.6±10.6 5.60±1.63 44.00±5.04
对照组2 30 14/16 61.5±13.1 5.73±1.60 44.00±4.91
试验组 30 16/14 63.2±11.1 5.63±1.65 45.00±4.38
F/χ2值 ? 0.224 0.011 0.255 0.319
P值 ? 0.626 0.989 0.775 0.727
图1 床旁快速置入颅内压探头的示意图
图2 高血压脑出血患者床旁快速颅内压探头置入颅内压监测和血肿穿刺减压的影像资料
表2 3组患者开颅准备时间、NICU住院时间比较
组别 例数 开颅准备时间（min） NICU住院时间（d）
对照组1 30 78±18 7.05±1.78
对照组2 30 66±10 10.60±1.67
试验组 30 79±23 5.87±1.38ab
F值 ? 0.015 29.598
P值 ? 0.972 0.001
表3 3组患者术后颅内压比较
组别 例数 术后当天 术后1 d 术后3 d 术后5 d
对照组1 30 7.43±1.41 12.70±2.57 14.83±1.84 16.57±1.97
对照组2 30 8.03±1.13 13.97±1.94 18.10±2.04 19.50±2.71
试验组 30 7.80±1.67 12.87±2.24 13.03±1.50ab 14.30±1.90ab
F值 ? 0.990 1.024 10.510 20.520
P值 ? 0.376 0.354 0.002 0.001
表4 3组患者术后GCS评分比较
组别 例数 术后1 d 术后1周 术后1个月
对照组1 30 8.57±1.26 9.67±1.41 10.27±1.41
对照组2 30 8.52±0.98 8.43±0.97 9.43±0.97
试验组 30 8.87±0.86 10.07±1.39ab 11.07±1.44ab
F值 ? 1.095 10.996 14.197
P值 ? 0.315 0.001 0.001
[1]
Hemphill JC, Greenberg SM, Anderson CS, et al. Guidelines for the management of spontaneous intracerebral hemorrhage:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2015, 46(7): 2032-2060.
[2]
薛元峰，潘榆春，曾武,等.重症脑出血患者颅内压相关参数与预后的关系[J].南方医科大学学报(自然科学版), 2019, 39(8): 1211-1213.
[3]
Tsai CF, Anderson N, Thomas B, et al. Comparing risk factor profiles between intracerebral hemorrhage and ischemia stroke in Chinese and white populations: systematic review and meta-analysis[J]. PLoS One, 2016, 11(3): e0151743.
[4]
Provencio JJ, Da Silva IR, Manno EM. Intracerebral hemorrhage: new challenges and steps forward[J]. Neurosurg Clin N Am, 2013, 24(3): 349-359.
[5]
Leonardo DOMA, Goffi A, Zampieri F, et al. The critical care management of spontaneous intracranial hemorrhage: a contemporary review[J]. Critical Care, 2016, 20(1): 272-301.
[6]
Kamel H, Hemphill JC, 3rd. Characteristics and sequelae of intracranial hypertension after intracerebral hemorrhage[J]. Neurocrit Care, 2012, 17(2): 172-176.
[7]
Ziai WC, Melnychuk E, Thompson CB, et al. Occurrence and impact of intracranial pressure elevation during treatment of severe intraventricular hemorrhage[J]. Crit Care Med, 2012, 40(5): 1601-1608.
[8]
王佳，袁鹏，胡晞,等.颅内压监测在中等量高血压脑出血治疗中的应用[J].中华神经外科疾病研究杂志, 2018, 17(2): 118-121.
[9]
Tian Y, Wang Z, Jia Y, et al. Intracranial pressure variability predicts short-term outcome after intracerebral hemorrhage: a retrospective study[J]. J Neurol Sci, 2013, 330(1-2): 38-44.
[10]
张东，陈来照，梁宗星，等.颅内压监测临床研究现状及相关参数进展[J].中华神经创伤外科电子杂志, 2019, 5(4): 248-252.
[11]
Sykora M, Steinmacher S, Steiner T, et al. Association of intracranial pressure with outcome in comatose patients with intracerebral hemorrhage[J]. J Neurol Sci, 2014, 342(1-2): 141-145.
[12]
Specogna AV, Turin TC, Patten SB, et al. Factors associated with early deterioration after spontaneous intracerebral hemorrhage: a systematic review and meta-analysis[J]. PLoS One, 2014, 9(5): e96743.
[13]
Brott T, Broderick J, Kothari R, et al. Early hemorrhage growth in patients with intracerebral hemorrhage[J]. Stroke, 1997, 28(1): 1-5.
[14]
顾洪库，冯国余，胡国宏,等. CT定位微创治疗高血压脑出血脑疝患者疗效分析[J].中华神经外科疾病研究杂志, 2018, 17(2): 75-77.
[15]
Bao YH, Liang YM, Gao GY, et al. Bilateral decompressive craniectomy for patients with malignant diffuse brain swelling after severe traumatic brain injury: a 37-case study[J]. J Neurotrauma, 2010, 27(2): 341-347.
[1] 张馨月, 韩帅, 张舒石, 李文臣, 张舒岩. 颅内压监测技术在创伤性颅脑损伤治疗中的应用[J]. 中华神经创伤外科电子杂志, 2023, 09(04): 246-252.
[2] 张付意, 侯现增, 汪建军, 辛涛. 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[J]. 中华神经创伤外科电子杂志, 2022, 08(05): 298-301.
[3] 张永明, 马奎, 余浩, 邓鹏程, 许少年. 神经外科机器人引导下精准穿刺治疗脑内亚急性小血肿[J]. 中华神经创伤外科电子杂志, 2022, 08(02): 127-128.
[4] 许少年, 张永明, 黄振山, 丁俊, 姜国伟, 钱峰, 张连富. 机器人辅助下立体定向微创穿刺抽吸及引流术治疗高血压脑出血的临床疗效分析[J]. 中华神经创伤外科电子杂志, 2022, 08(02): 76-80.
[5] 魏宜功, 周焜, 陈光唐, 王诚, 刘窗溪. 颅内压监测下改良阶梯减压法结合去骨瓣减压治疗颅内高压的疗效分析[J]. 中华神经创伤外科电子杂志, 2022, 08(01): 28-33.
[6] 何鑫, 武秀权, 费舟, 费霏. 与视器相关的无创颅内压监测[J]. 中华神经创伤外科电子杂志, 2021, 07(06): 372-375.
[7] 管诚, 沈剑虹, 管义祥, 陈建静. 标准大骨瓣减压结合腰大池持续引流术对重型颅脑损伤的疗效与预后的影响[J]. 中华神经创伤外科电子杂志, 2021, 07(05): 281-287.
[8] 程岗, 李彦腾, 魏铂沅, 王淑为, 刘帅, 刘邦鑫, 刘亚楠, 张剑宁. 不同海战环境爆炸后比格犬颅内外压力变化特点的实验研究[J]. 中华神经创伤外科电子杂志, 2021, 07(01): 6-11.
[9] 曹炜, 王翠雪, 徐珊珊, 袁媛, 张琳琳, 周建新. 不同头高位对aSAH患者术后颅内压及脑灌注压的影响[J]. 中华重症医学电子杂志, 2022, 08(02): 121-125.
[10] 刘政委, 仪立志, 尹夕龙, 孔文龙, 纠智松, 张文源. 锥颅血肿外引流与神经内镜手术治疗老年基底节区高血压性脑出血的疗效分析[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(05): 299-303.
[11] 王煜泽, 高文文, 杨磊, 赵海康. 无创监测技术在脑水肿应用的研究进展[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(02): 113-117.
[12] 陈晨, 徐宏, 李政, 韩杨云. 脑室内颅内压监测在重型颅脑损伤患者围术期的应用研究[J]. 中华脑科疾病与康复杂志(电子版), 2022, 12(03): 146-151.
[13] 谷雪峰, 王晓虹. 高血压脑出血患者术后不同程度抑郁风险因素模型构建及验证[J]. 中华脑科疾病与康复杂志(电子版), 2020, 10(05): 316-320.
[14] 沈书廷, 马飞虎, 龙翔, 牧仁, 王建武, 钱磊, 刘俊鹏, 孟宪东, 张宗林. 高血压性脑出血分型及外科治疗方法选择的探讨[J]. 中华脑科疾病与康复杂志(电子版), 2020, 10(05): 309-315.
[15] 朱旭, 郭翠霞, 魏洁, 张宁, 王喜旺, 于国渊. 脑灌注压联合血小板体积指数对颅内动脉瘤栓塞术后迟发性脑缺血的预测价值[J]. 中华脑血管病杂志(电子版), 2022, 16(06): 392-397.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号