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

doi:10.3877/cma.j.issn.2095-9141.2020.02.008

Abstract

Abstract:

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 1^st day after operation (P>0.05), on the 3^rd and 5^th 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 1^st 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

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.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhsjcswkdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9141.2020.02.008

https://zhsjcswkdzzz.cma-cmc.com.cn/EN/Y2020/V06/I02/100

Figures/Tables 6

References 15

[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.

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

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

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±1.38^ab
F值	?	0.015	29.598
P值	?	0.972	0.001

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±1.38^ab
F值	?	0.015	29.598
P值	?	0.972	0.001

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±1.50^ab	14.30±1.90^ab
F值	?	0.990	1.024	10.510	20.520
P值	?	0.376	0.354	0.002	0.001

Please choose a citation manager

Content to export