持续有创颅内压监测的应用对小骨窗开颅血肿清除术治疗脑出血患者预后的影响
|
摘要
目的探讨持续有创颅内压监测的应用对小骨窗开颅血肿清除术治疗自发性基底核脑出血患者预后的影响。方法选择行小骨窗开颅血肿清除术治疗的初发性自发性基底核脑出血患者140例,将患者分为观察组66例和对照组74例,其中观察组术中在血肿腔内植入带脑室导管颅内压探头行术后持续颅内压监测并指导治疗。分析两组患者术后6个月神经功能预后不良(格拉斯哥预后评分1~3分)的影响因素。结果观察组、对照组患者手术持续时间、术中出血量、术后再出血和颅内感染发生率比较,差异均无统计学意义(均P>0.05)。观察组患者术后甘露醇使用量、术后急性肾损伤发生率和术后6个月神经功能预后不良比例显著下降(均P<0.05)。多因素分析提示,术中植入颅内压探头术后实时监测颅内压指导临床治疗是脑出血患者术后6个月神经功能恢复的保护性因素(P<0.05)。结论术中植入颅内压探头、术后实时监测颅内压指导脑出血治疗安全可靠,能显著改善患者的预后,值得临床推广应用。
Objective To evaluate the application of continuous invasive bone intracranial pressure monitoring Methods for patients hundred with forty intracerebral intracerebral cases hemorrhage hemorrhage following patients evacuation treated of hematoma small by small window craniotomy.evacuation One with bone window craniotomy for of hematoma,among whom 66underwent implantation of intracranial of pressure treatment probe during operation and postoperative real-time monitoring of was intracranial pressure for guidance group).clinical(study group),and 74 cases received conventional months postoperative surgery management compared(control The neurological Results function(Glasgow outcome scale score sex,1-3)6 after between mellitus,two groups.There score were no significant differences in age,complicated hypertension of and into and The diabetes Glasgow coma scale at admission,and preoperative hematoma operation volume,extending hematoma intraventricular incidence space,time between stroke onset operation,length of time,intraoperative bleeding volume,of postoperative dose rebleeding and renal intracranial impairment infection and were compared poor between two groups(all P>0.05).postoperative study of mannitol,rate lower of incidence of prognosis in neurological function at 6 month in group were significantly than probe for those and in control group(all P<0.05).Multivariate analysis showed that intraoperative implantation treatment of was intracranial a pressure postoperative real-time monitoring of intracranial after pressure for guidance of clinical protective factor recover of neurological function 6 months surgery in patients with intracerebral hemorrhage(P<0.05).Conclusion Intraoperative implantation of intracranial pressure probe and postoperative real-time monitoring following of intracranial pressure for guiding clinical treatment is safe and effective in patients with intracerebral hemorrhage small bone widow craniotomy.
Objective To evaluate the application of continuous invasive bone intracranial pressure monitoring Methods for patients hundred with forty intracerebral intracerebral cases hemorrhage hemorrhage following patients evacuation treated of hematoma small by small window craniotomy.evacuation One with bone window craniotomy for of hematoma,among whom 66underwent implantation of intracranial of pressure treatment probe during operation and postoperative real-time monitoring of was intracranial pressure for guidance group).clinical(study group),and 74 cases received conventional months postoperative surgery management compared(control The neurological Results function(Glasgow outcome scale score sex,1-3)6 after between mellitus,two groups.There score were no significant differences in age,complicated hypertension of and into and The diabetes Glasgow coma scale at admission,and preoperative hematoma operation volume,extending hematoma intraventricular incidence space,time between stroke onset operation,length of time,intraoperative bleeding volume,of postoperative dose rebleeding and renal intracranial impairment infection and were compared poor between two groups(all P>0.05).postoperative study of mannitol,rate lower of incidence of prognosis in neurological function at 6 month in group were significantly than probe for those and in control group(all P<0.05).Multivariate analysis showed that intraoperative implantation treatment of was intracranial a pressure postoperative real-time monitoring of intracranial after pressure for guidance of clinical protective factor recover of neurological function 6 months surgery in patients with intracerebral hemorrhage(P<0.05).Conclusion Intraoperative implantation of intracranial pressure probe and postoperative real-time monitoring following of intracranial pressure for guiding clinical treatment is safe and effective in patients with intracerebral hemorrhage small bone widow craniotomy.
引文
[1]Morotti A,Goldstein JN.Diagnosis and Management of Acute Hemorrhage[J].Emerg Med Clin North Am,2016,34(4):883-899.doi:10.1016/j.emc.2016.06.010.
[2]Chi FL,Lang TC,Sun SJ,et al.Relationship between different surgical methods,hemorrhage position,hemorrhage volume,surgical timing,and treatment outcome of hypertensive intracerebral hemorrhage[J].World J Emerg Med,2014,5(3):203-208.doi:10.5847/wjem.j.1920-8642.2014.03.008.
[3]Wang W,Zhou N,Wang C.Minimally Invasive Surgery for Patients with Hypertensive Intracerebral Hemorrhage with Large Hematoma Volume:A Retrospective Study[J].World Neurosurg,2017,105:348-358.doi:10.1016/j.wneu.2017.05.158.626
[4]Rannikm a e K,Woodfield R,Anderson CS,et al.Reliability of intracerebral hemorrhage classification systems:A systematic review[J].Int J Stroke,2016,11(6):626-636.doi:10.1177/1747493016641962.
[5]Cai X,Rosand J.The Evaluation and Management of Adult Intracerebral Hemorrhage[J].Semin Neurol,2015,35(6):638-645.doi:10.1055/s-0035-1564687.
[6]Kim JY,Bae HJ.Spontaneous Intracerebral Hemorrhage:Management[J].J Stroke,2017,19(1):28-39.doi:10.5853/jos.2016.01935.
[7]Alali AS,Fowler RA,Mainprize TG,et al.Intracranial pressure monitoring in severe traumatic brain injury:results from the American College of Surgeons Trauma Quality Improvement Program[J].J Neurotrauma,2013,30(20):1737-1746.doi:10.1089/neu.2012.2802.
[8]Dash HH,Chavali S.Management of traumatic brain injury patients[J].Korean J Anesthesiol,2018,71(1):12-21.doi:10.4097/kjae.2018.71.1.12.
[9]Galgano M,Toshkezi G,Qiu X,et al.Traumatic Brain Injury:Current Treatment Strategies and Future Endeavors[J].Cell Transplant,2017,26(7):1118-1130.doi:10.1177/0963689717714102.
[10]Yu SX,Zhang QS,Yin Y,et al.Continuous monitoring of intracranial pressure for prediction of postoperative complications of hypertensive intracerebral hemorrhage[J].Eur Rev Med Pharmacol Sci,2016,20(22):4750-4755.
[11]Liu Z,Chen Q,Tian D,et al.Clinical significance of dynamic monitoring by transcranial doppler ultrasound and intracranial pressure monitor after surgery of hypertensive intracerebral hemorrhage[J].Int J Clin Exp Med,2015,8(7):11456-11462.
[12]Rennert RC,Signorelli JW,Abraham P,et al.Minimally invasive treatment of intracerebral hemorrhage[J].Expert Rev Neurother,2015,15(8):919-933.doi:10.1586/14737175.2015.1059755.
[13]Akhigbe T,Okafor U,Sattar T,et al.Stereotactic-Guided Evacuation of Spontaneous Supratentorial Intracerebral Hemorrhage:Systematic Review and Meta-Analysis[J].World Neurosurg,2015,84(2):451-460.doi:10.1016/j.wneu.2015.03.051.
[14]Kim JE,Ko SB,Kang HS,et al.Clinical practice guidelines for the medical and surgical management of primary intracerebral hemorrhage in Korea[J].J Korean Neurosurg Soc,2014,56(3):175-187.doi:10.3340/jkns.2014.56.3.175.
[15]Chan S,Hemphill JC 3rd.Critical care management of intracerebral hemorrhage[J].Crit Care Clin,2014,30(4):699-717.doi:10.1016/j.ccc.2014.06.003.
[16]Vespa PM,Martin N,Zuccarello M,et al.Surgical trials in intracerebral hemorrhage[J].Stroke,2013,44(6 Suppl 1):S79-82.doi:10.1161/STROKEAHA.113.001494.
[17]Zhao Y,Yang J,Zhao H,et al.The association between hyperglycemia and the prognosis of acute spontaneous intracerebral hemorrhage[J].Neurol Res,2017,39(2):152-157.doi:10.1080/01616412.2016.1270575.
[18]You S,Shi L,Zhong C,et al.Prognostic Significance of Estimated Glomerular Filtration Rate and Cystatin C in Patients with Acute Intracerebral Hemorrhage[J].Cerebrovasc Dis,2016,42(5-6):455-463.doi:10.1159/000448340.
[19]Roquer J,Rodríguez-Campello A,Jiménez-Conde J,et al.Sex-related differences in primary intracerebral hemorrhage[J].Neurology,2016,87(3):257-262.doi:10.1212/WNL.0000000000002792.
[2]Chi FL,Lang TC,Sun SJ,et al.Relationship between different surgical methods,hemorrhage position,hemorrhage volume,surgical timing,and treatment outcome of hypertensive intracerebral hemorrhage[J].World J Emerg Med,2014,5(3):203-208.doi:10.5847/wjem.j.1920-8642.2014.03.008.
[3]Wang W,Zhou N,Wang C.Minimally Invasive Surgery for Patients with Hypertensive Intracerebral Hemorrhage with Large Hematoma Volume:A Retrospective Study[J].World Neurosurg,2017,105:348-358.doi:10.1016/j.wneu.2017.05.158.626
[4]Rannikm a e K,Woodfield R,Anderson CS,et al.Reliability of intracerebral hemorrhage classification systems:A systematic review[J].Int J Stroke,2016,11(6):626-636.doi:10.1177/1747493016641962.
[5]Cai X,Rosand J.The Evaluation and Management of Adult Intracerebral Hemorrhage[J].Semin Neurol,2015,35(6):638-645.doi:10.1055/s-0035-1564687.
[6]Kim JY,Bae HJ.Spontaneous Intracerebral Hemorrhage:Management[J].J Stroke,2017,19(1):28-39.doi:10.5853/jos.2016.01935.
[7]Alali AS,Fowler RA,Mainprize TG,et al.Intracranial pressure monitoring in severe traumatic brain injury:results from the American College of Surgeons Trauma Quality Improvement Program[J].J Neurotrauma,2013,30(20):1737-1746.doi:10.1089/neu.2012.2802.
[8]Dash HH,Chavali S.Management of traumatic brain injury patients[J].Korean J Anesthesiol,2018,71(1):12-21.doi:10.4097/kjae.2018.71.1.12.
[9]Galgano M,Toshkezi G,Qiu X,et al.Traumatic Brain Injury:Current Treatment Strategies and Future Endeavors[J].Cell Transplant,2017,26(7):1118-1130.doi:10.1177/0963689717714102.
[10]Yu SX,Zhang QS,Yin Y,et al.Continuous monitoring of intracranial pressure for prediction of postoperative complications of hypertensive intracerebral hemorrhage[J].Eur Rev Med Pharmacol Sci,2016,20(22):4750-4755.
[11]Liu Z,Chen Q,Tian D,et al.Clinical significance of dynamic monitoring by transcranial doppler ultrasound and intracranial pressure monitor after surgery of hypertensive intracerebral hemorrhage[J].Int J Clin Exp Med,2015,8(7):11456-11462.
[12]Rennert RC,Signorelli JW,Abraham P,et al.Minimally invasive treatment of intracerebral hemorrhage[J].Expert Rev Neurother,2015,15(8):919-933.doi:10.1586/14737175.2015.1059755.
[13]Akhigbe T,Okafor U,Sattar T,et al.Stereotactic-Guided Evacuation of Spontaneous Supratentorial Intracerebral Hemorrhage:Systematic Review and Meta-Analysis[J].World Neurosurg,2015,84(2):451-460.doi:10.1016/j.wneu.2015.03.051.
[14]Kim JE,Ko SB,Kang HS,et al.Clinical practice guidelines for the medical and surgical management of primary intracerebral hemorrhage in Korea[J].J Korean Neurosurg Soc,2014,56(3):175-187.doi:10.3340/jkns.2014.56.3.175.
[15]Chan S,Hemphill JC 3rd.Critical care management of intracerebral hemorrhage[J].Crit Care Clin,2014,30(4):699-717.doi:10.1016/j.ccc.2014.06.003.
[16]Vespa PM,Martin N,Zuccarello M,et al.Surgical trials in intracerebral hemorrhage[J].Stroke,2013,44(6 Suppl 1):S79-82.doi:10.1161/STROKEAHA.113.001494.
[17]Zhao Y,Yang J,Zhao H,et al.The association between hyperglycemia and the prognosis of acute spontaneous intracerebral hemorrhage[J].Neurol Res,2017,39(2):152-157.doi:10.1080/01616412.2016.1270575.
[18]You S,Shi L,Zhong C,et al.Prognostic Significance of Estimated Glomerular Filtration Rate and Cystatin C in Patients with Acute Intracerebral Hemorrhage[J].Cerebrovasc Dis,2016,42(5-6):455-463.doi:10.1159/000448340.
[19]Roquer J,Rodríguez-Campello A,Jiménez-Conde J,et al.Sex-related differences in primary intracerebral hemorrhage[J].Neurology,2016,87(3):257-262.doi:10.1212/WNL.0000000000002792.