连续动态颅内压监测在脑出血治疗中的应用评价

目的研究连续动态颅内压监测在脑出血治疗中的应用价值。方法选择我院神经外科2012年2月至2013年2月收治的72例高血压脑出血患者,行头颅CT检查确诊,出血量在30~50 ml之间。单纯基底节部出血42例,随机分为监测组与对照组,每组21例。基底节部出血并破入脑室者30例,随机分为监测组与对照组,每组15例。监测组连续监测颅内压3~7 d;对照组采用传统方法评价颅内压。当发现有颅内压升高的情况两组均采取及时降压的措施。对比患者出入院前后格拉斯哥评分(GCS)以及平均住院时间。结果对于单纯基底节部出血患者,出院时颅内压监测组GCS评分高于对照组(P0.05),颅内压监测组住院时间少于对照组(P0.05)。对于基底节部出血并破入脑室患者,出院时GCS评分监测组与对照组比较无统计学差异(P0.05);两组住院时间比较亦无统计学差异(P0.05)。结论连续动态颅内压监测在高血压脑出血治疗中可早期发现颅内压变化,进而指导采取相应合理的治疗措施,最终可以改善患者预后,降低死残率,具有很高的临床应用价值。

Evaluation of continuous dynamic intracranial pressure monitoring in the treatment of cerebral hemorrhage

Objective The clinical evaluation of the continuous dynamic monitoring of intracranial pressure in the treatment of cerebral hemorrhage is investigated.Methods A total of 72 cases of hypertensive cerebral hemorrhage hospitalized in our department from February 2012 to February 2013 were selected,all of which were performed head CT examination and confirmed the amount of bleeding between 30 and 50 ml.Forty-two cases of pure basal ganglia hemorrhage were randomly divided into the monitoring group and control group with 21 cases in each group.Thirty cases of basal ganglia hemorrhage broking into ventricles were randomly divided into monitoring group and control group,with 15 cases in each group.Continuous monitoring of intracranial pressure monitoring group lasted for 3 ～7 d; traditional methods were used for evaluating intracranial pressure in the control group.When increased intracranial pressure was found,the measures to reduce intracranial pressure were taken timely.Glasgow Cona Score （C CS） before and after treatment and the average length of stay were compared between two groups.Results For the patients with pure basal ganglia hemorrhage,GCS of intracranial pressure monitoring group at discharge was higher than that of control group （P 〈0.05）,and the hospitalization time of monitoring group was shorter than that of control group （P 〈0.05）.For the patients with basal ganglia hemorrhage broking into ventricles,GCS at discharge showed no significant difference between monitoring and control groups （P〉0.05） ; and there was no significant difference in the length of hospital stay between two groups （P 〉 0.05）.Conclusion Continuous dynamic monitoring of intracranial pressure can detect the changes of intracranial pressure timely in the treatment of hypertensive cerebral hemorrhage,and then the appropriate and reasonable treatment measures could be taken to improve the outcomes of patients.