有创颅内压监测在大面积脑梗死治疗中的作用

目的观察有创颅内压监测(ICP)在大面积脑梗死治疗中的临床效果。方法选取河南省人民医院神经外科ICU 2018-01—2019-05收治的42例急性大面积脑梗死患者,按治疗方式的不同分为2组,观察组21例,与患者家属沟通后,同意床边急诊行ICP脑室型传感器(Codman ICP,美国强生公司)置入术,ICP持续上升且>25 mmHg(1 mmHg=0.133 kPa),急诊行去骨瓣减压手术。对照组21例患者,入院时家属拒绝行ICP置入术,复查颅脑CT或MRI显示中线移位>1 cm+单侧或双侧瞳孔散大+GCS评分进行性下降时,急诊行标准去骨瓣减压术。观察2组术后GOS预后分级法评定临床治疗效果,与存活患者ICU总住院费用及住院时间、并发症进行对比。结果术后随访6个月,观察组死亡8例,病死率38.1%;存活13例患者,存活率61.9%;GOS分级Ⅰ级8例,Ⅱ级5例,Ⅲ级4例,Ⅳ级4例,Ⅴ级0例;其中恢复良好(Ⅲ级+Ⅳ级+Ⅴ级)8例,良好率38.1%。对照组死亡2例,病死率9.5%;存活19例,存活率90.5%。GOS分级Ⅰ级2例,Ⅱ级3例,Ⅲ级8例,Ⅳ级7例,Ⅴ级1例,其中恢复良好16例,良好率76.2%。2组临床有效率比较差异有统计学意义(P<0.05)。2组消化道出血、电解质紊乱、肺部感染等并发症发生率比较差异无统计学意义(P>0.05)。观察组ICU总住院费用及住院时间明显低于对照组,差异有统计学意义(P<0.05)。结论ICP能够及时动态把握大面积脑梗死患者颅内压变化,有利于观察临床手术指征并确定手术最佳时机,从而为临床实施手术提供有效、直观的量化指标,也同时为此类患者的成功救治提供新的方向。

Effect of invasive intracranial pressure monitoring in the treatment of large area cerebral infarction

Objective To observe the clinical effect of invasive intracranial pressure monitoring(ICP)in the treatment of large area cerebral infarction.Methods A total of 42 patients with acute large-area cerebral infarction admitted to the Department of Neurosurgery ICU of Henan Provincial People's Hospital from January 2018 to May 2019 were divided into two groups according to different treatment methods.21 patients in the observation group,after communicating with the patient's family,agreed to the bed.In the emergency department,the ICP ventricle sensor(Codman ICP,Johnson&Johnson,USA)was placed,the ICP continued to rise and>25 mmHg(1 mmHg=0.133 kPa),and the decompressive surgery was performed in the emergency department.In the control group of 21 patients,the family refused to undergo ICP implantation at the time of admission.The CT scan of the brain or MRI showed a midline shift>1 cm+unilateral or bilateral pupil dilated+GCS score progressively decreased.The clinical outcomes of the two groups were evaluated by postoperative GOS prognosis grading method,and compared with the total hospitalization cost,hospitalization time and complications of surviving patients.Results After 6 months of follow-up,8 patients died in the observation group,and the mortality rate was 38.1%.Survival rate was 61.9%in 13 patients.There were 8 grades in gradeⅠ,5 in gradeⅡ,4 in gradeⅢ,and 4 in gradeⅣ.8 cases of good recovery(ClassⅢ+Ⅳ+Ⅴ),the good rate was 38.1%.In the control group,2 patients died,and the mortality rate was 9.5%.In 19 patients,the survival rate was 90.5%.There were 2 cases of gradeⅠin grade 2,3 cases in gradeⅡ,8 cases in gradeⅢ,7 cases in gradeⅣ,and 1 case in gradeⅤ.Among them,16 cases recovered well,and the good rate was 76.2%.The difference in clinical effective rate between the two groups was statistically significant(P<0.05).There was no significant difference in the incidence of complications between the two groupsgastrointestinal bleeding,electrolyte imbalance,and pulmonary infection(P>0.05).The total hospitalization expenses and hospitalization time of the ICU in the observation group were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).Conclusion ICP can dynamically and dynamically grasp the changes of intracranial pressure in patients with large-area cerebral infarction,which is beneficial to observe the indications of clinical operation and determine the optimal timing of surgery,so as to provide effective and intuitive quantitative indicators for clinical implementation of surgery,and provides a new direction for treatment of such patients.