围术期颅内压监测对高血压脑出血患者微创颅内血肿抽吸术的指导价值

doi:10.3969/j.issn.1671-7171.2023.04.031

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摘要【目的】探讨围术期颅内压(ICP)监测对高血压脑出血(HICH)患者微创颅内血肿抽吸术的指导价值。【方法】回顾性分析2017年4月至2019年4月宝鸡高新医院神经外科收治的138例行微创颅内血肿抽吸术治疗的HICH患者的临床资料,根据治疗方法的不同将其分为观察组和对照组,每组69例。对照组采用微创颅内血肿抽吸术治疗,观察组在对照治疗的基础上放置ICP监测,将ICP阈值定为 15 mmHg,达到阈值立即停止抽吸。记录两组术中抽吸血肿量、抽吸血肿量占初始血肿量的百分比、术后血肿排空时间及再出血率,此外评价两组治疗前、治疗后(发病后4周时)的神经功能缺损情况。术后随访3~12个月,评估两组患者术后转归结局,统计良好率。【结果】观察组术中抽吸血肿量、抽吸血肿量占初始血肿量的百分比、术后血肿排空时间及再出血率低于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者斯堪的那维亚卒中量表(SSS)评分均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。随访3~12个月,两组均无死亡病例。观察组术后转归结局良好率为65.2%(44/69),高于对照组的46.4%(32/69),差异有统计学意义(χ²=4.965,P<0.05)。【结论】HICH微创治疗围术期持续ICP监测可有效降低手术过量抽吸引起再出血发生风险,同时指导术后阶梯式治疗,改善患者预后,具有较高的临床应用价值。

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	李虎
	曹宁

关键词 ：颅内出血,高血压性/外科学, 血肿/外科学, 颅内压

Abstract：【Objective】 To explore the guiding value of perioperative intracranial pressure (ICP) monitoring in minimally invasive intracranial hematoma aspiration surgery for hypertensive intracerebral hemorrhage (HICH). 【Methods】 The clinical data of 138 cases HICH patients treated by minimally invasive intracranial hematoma aspiration from April 2017 to April 2019 in Baoji High-Tech Hospital neurosurgery were retrospectively analyzed. According to the different treatment methods,they were divided into an observation group and a control group,with 69 cases in each group. The control group was treated with minimally invasive intracranial hematoma aspiration surgery,while the observation group added ICP monitoring to the control treatment. The ICP threshold was set at 15 mmHg,and aspiration was immediately stopped when the threshold was achieved. The volume of intraoperative blood suction,the percentage of blood suction volume to the initial hematoma volume,the evacuation time of postoperative hematoma,and the rate of rebleeding were recorded for both groups. In addition,the neurological deficits before and after treatment (4 weeks after onset) were evaluated for both groups. Postoperative follow-up was conducted for 3-12 months to evaluate the postoperative outcomes of both groups of patients,and the good rate was statistically analyzed. 【Results】 The observation group had significantly lower intraoperative hematoma volume,percentage of hematoma volume to initial hematoma volume,postoperative hematoma evacuation time,and rebleeding rate compared to the control group (P<0.05). After treatment,the SSS scores of both groups of patients were lower than before treatment,and the observation group was lower than the control group,with a statistically significant difference (P<0.05). Following up for 3~12 months,there were no deaths in either group. The good postoperative outcome rate in the observation group was 65.2% (44/69),higher than 46.4% (32/69) in the control group,with a statistically significant difference (χ²=4.965,P<0.05). 【Conclusion】 Continuous ICP monitoring during the perioperative period of HICH minimally invasive treatment can effectively reduce the risk of rebleeding caused by excessive suction during surgery,guide postoperative stepwise treatment,improve prognosis,and have high clinical application value.

Key words： Intracranial Hemorrhage,Hypertensive/SU Hematoma/SU Intracranial Pressure

收稿日期: 2022-03-15

中图分类号:

R743.2

通讯作者: * E-mail:caoning1107@163.com

引用本文:

李虎, 曹宁. 围术期颅内压监测对高血压脑出血患者微创颅内血肿抽吸术的指导价值[J]. 医学临床研究, 2023, 40(4): 592-595.
LI Hu, CAO Ning. Guiding Value of Perioperative Intracranial Pressure Monitoring in Minimally Invasive Intracranial Hematoma Aspiration Surgery for Hypertensive Intracerebral Hemorrhage. JOURNAL OF CLINICAL RESEARCH, 2023, 40(4): 592-595.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2023.04.031 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2023/V40/I4/592

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