|
|
|
| Guiding Value of Perioperative Intracranial Pressure Monitoring in Minimally Invasive Intracranial Hematoma Aspiration Surgery for Hypertensive Intracerebral Hemorrhage |
| LI Hu, CAO Ning |
| Department of Neurosurgery,Baoji High-Tech Hospital,Baoji Shaanxi 721013 |
|
|
|
|
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.
|
|
Received: 15 March 2022
|
|
|
|
|
|
[1] 王博,韦明炯,惠一鸣,等.改良立体定向联合术中B超精准定位微创治疗高血压脑出血的临床研究[J].医学临床研究,2019,36(4):675-677.
[2] 任军伟,吴惺,胡锦,等. 自发性脑出血患者的颅内压、脑灌注压与血压调控研究进展[J].国际神经病学神经外科学杂志,2016,43(3):251-254.
[3] 韦拳堂,钟志伟,张子衡,等. 颅内压监测在高血压脑出血微创治疗中的应用[J].实用医学杂志,2016,32(7):1136-1139.
[4] 李斌,符星,钟丽瑶,等. 颅内压监测和化痰通腑醒脑法治疗高血压脑出血的临床疗效[J].实用医学杂志,2016,32(22):3785-3787.
[5] 李风志,徐海波. 微创颅内血肿抽吸术对高血压脑出血患者神经功能的影响[J].中国卫生标准管理,2015,6(20):47-48.
[6] 陈刚,程继勇. 开颅血肿清除术和钻孔引流术治疗高血压脑出血疗效比较[J].中国神经精神疾病杂志,2016,42(7):431-434.
[7] 徐梅华,田恒力,高文伟,等. 体位变化对高血压脑出血术后颅内压和脑灌注压的影响[J].护理研究,2018,32(5):790-792.
[8] PARK P,GARTON H J,KOCAN M J,et al. Risk of infection with prolonged ventricular catheterization[J].Neurosurgery,2004,55(3):594-601.
[9] TAMAKI T,NODE Y,YAMAMOTO Y,et al. Cardiopulmonary hemodynamic changes during acute subdural hematoma evacuation[J].Neurol Med Chir (Tokyo),2006,46(5):219-225.
[10] 高进保,李学真,李文德,等. 动态颅内压监测在高血压小脑出血手术治疗中的应用[J].中国实用神经疾病杂志,2018,21(12):1325-1329.
[11] 刘汶,刘健. 连续动态颅内压监测对高血压脑出血预后的意义[J].中国老年学杂志,2015,35(20):5791-5792.
[12] 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.
[13] 张禄波,遇旭东,傅继东,等. 持续颅内压监测在高血压脑出血术后的应用及灵敏度分析[J].中国临床医生杂志,2017,45(8):67-69.
[14] 何川,陈慎之,潘建南,等. 高血压脑出血患者应用持续颅内压监测的临床意义[J].中国实用神经疾病杂志,2016,19(18):1-3. |
|
|
|
2023, Vol. 40 
