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.
作者
张立新
蔡东敏
徐茂法
宋清安
董晓巧
陈景森
王林
ZHANG Lixin;CAI Dongmin;XU Maofa(Department of Neurosurgery,Hangzhou Dajiangdong Hospital,Hangzhou 311225,China)
出处
《浙江医学》
CAS
2018年第16期1814-1818,共5页
Zhejiang Medical Journal
基金
杭州市科技发展计划项目(20150633B63)
杭州市余杭区科技计划项目(2015006)
关键词
脑出血
颅内压监测
小骨窗开颅
血肿清除术
预后
Intracerebral hemorrhage
Intracranial pressure monitoring
Small bone window craniotomy
Evacua-tion of hematoma
Prognosis
