Application and efficacy of intracranial pressure monitoring in the treatment of hypertensive intracerebral hemorrhage with non-cerebral hernia

doi:10.3877/cma.j.issn.2095-9141.2020.03.005

Abstract

Abstract:

Objective

To explore the guiding value of intracranial pressure (ICP) monitoring in the choice of surgical methods for patients with hypertensive intracerebral hemorrhage with non-cerebral hernia and to analyze the postoperative efficacy.

Methods

A total of 73 patients with hypertensive intracerebral hemorrhage and non-cerebral hernia treated in the Neurosurgery Center of the First Affiliated Hospital of Xinjiang Medical University from 2018 February to October were selected and divided into monitoring group (37 cases) and control group (36 cases) according to whether they underwent ICP monitor probe implantation before surgery. The monitoring group selected the operation method according to the ICP value combined with the preoperative CT, and determined the usage and dosage of mannitol after the operation. The control group only decided the operation method according to the patients' clinical manifestations and preoperative CT, and used mannitol empirically after surgery. The operative methods, postoperative complications and prognosis of the two groups were compared.

Results

The total postoperative dose of mannitol in the monitoring group was significantly lower than that in the control group, and the length of hospitaization was significantly shorter than that of the control group (P<0.05). The total incidence of postoperative complications including gastrointestinal bleeding, pulmonary infection, deep vein thrombosis, tracheotomy, and bone flap removal in the monitoring group was 21.6%, which was significantly lower than that in the control group (55.6%), The probability of patients with activities of daily living grade Ⅰ-Ⅱ in the monitoring group (81.08%) was significantly higher than that in the control group (55.56%), the difference was statistically significant (P<0.05).

Conclusion

Pre-operation ICP monitoring for non-cerebral hernia patients with hypertensive intracerebral hemorrhage can objectively guide the choice of surgical methods, which is of significance in reducing postoperative complications and avoiding radical osteotomy due to postoperative cerebral edema, and is of great help in accelerating postoperative rehabilitation and improving long-term quality of life.

Key words: Intracranial pressure monitoring, Cerebral hernia, Hypertensive cerebral hemorrhage, Small bone window, Microscope

Hao Wu, Yunlei Li, Mijiti Maimaitili·, Aisha Maiwulan·, Liexing Chen, Muertizha Mamutijiang·, Gonggaoang Bate·, Guohua Zhu. Application and efficacy of intracranial pressure monitoring in the treatment of hypertensive intracerebral hemorrhage with non-cerebral hernia[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2020, 06(03): 151-155.

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References 19

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组别	例数	男/女	年龄（岁）	出血量（mL）	发病时间（d）	出血侧别（左/右）	术前GCS评分
监护组	37	17/20	48.53±7.61	46.21±3.18	6.59±2.12	19/16	9.56±1.24
对照组	36	15/21	49.13±8.58	45.32±2.44	6.17±1.89	21/17	9.04±1.98
χ²/t值	?	0.136	0.316	1.339	0.893	0.007	1.349
P值	?	0.713	0.753	0.185	0.375	0.933	0.182

组别	例数	男/女	年龄（岁）	出血量（mL）	发病时间（d）	出血侧别（左/右）	术前GCS评分
监护组	37	17/20	48.53±7.61	46.21±3.18	6.59±2.12	19/16	9.56±1.24
对照组	36	15/21	49.13±8.58	45.32±2.44	6.17±1.89	21/17	9.04±1.98
χ²/t值	?	0.136	0.316	1.339	0.893	0.007	1.349
P值	?	0.713	0.753	0.185	0.375	0.933	0.182

组别	例数	甘露醇用量（g）			住院时间（d）
组别	例数	第1天	第3天	第7天	住院时间（d）
监护组	37	72.82±15.44	60.41±20.13	54.13±19.81	20.12±4.13
对照组	36	84.23±30.82	73.83±35.12	72.41±25.83	24.23±3.82
t值	?	2.008	2.010	3.399	4.411
P值	?	0.048	0.048	0.001	0.001

组别	例数	甘露醇用量（g）			住院时间（d）
组别	例数	第1天	第3天	第7天	住院时间（d）
监护组	37	72.82±15.44	60.41±20.13	54.13±19.81	20.12±4.13
对照组	36	84.23±30.82	73.83±35.12	72.41±25.83	24.23±3.82
t值	?	2.008	2.010	3.399	4.411
P值	?	0.048	0.048	0.001	0.001

组别	例数	胃肠道出血	肺部感染	深静脉血栓	气管切开	二次手术去骨瓣	发生率[例（%）]
监护组	37	2	3	1	2	0	8（21.6）
对照组	36	3	8	3	4	2	20（55.6）
χ²值	?	?	?	?	?	?	8.886
P值	?	?	?	?	?	?	0.003

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