急性HICH患者行FVEP ICP监测的临床应用价值

目的 探讨对急性高血压性脑出血(HICH)患者用闪光视觉诱发电位(FVEP)进行无创颅内压(ICP)监测的临床价值。方法 选取本院神经内科收治的110例急性HICH患者作为研究对象,根据患者治疗28 d的结局分为存活组87例和死亡组23例,分别对比2组患者入院后第12、24、48、72 h的ICP值,同时分析ICP值与患者的格拉斯哥昏迷评分(GCS)、急性生理与慢性健康评分(APACHEⅡ)、FVEP各波潜伏期的关系。结果 存活组患者的出血量、血弹值、WBC、中线移位发生率均显著低于死亡组(P<0.05); 在入院第12、24、48及72 h存活组患者的ICP值均显著低于死亡组患者(P<0.05); 在入院第12 h存活组患者的GCS评分显著高于死亡组患者(P<0.05),APACHEⅡ评分、FVEP各波潜伏期(P2、N2、P3、N3)均显著低于死亡组患者(P<0.05); 在入院第12 h HICH患者的ICP值与GCS评分呈显著负相关(r=-0.572,P<0.05),与APACHEⅡ评分、FVEP各波潜伏期(P2、N2、P3、N3)呈显著正相关(r=0.496,P<0.05)。结论 通过监测HICH患者的ICP值能够密切反映患者的病情程度、预后情况,对于指导临床治疗具有一定的价值。

The clinical value of ICP FVEP monitoring in patients suffered from HICH

ObjectiveTo investigate the clinical value of flash visual evoked potential(FVEP)in patients suffered from hypertensive intracerebral hemorrhage(HICH)for indicating noninvasive monitoring of intracranial pressure(ICP).Methods Select 110 cases of HICH patients from neurology department as research subjects. According to patient’s treatment outcomes 28 d later, they were divided into survival group and death group. There were 87 cases in survival group and 23 cases in death group, respectively. ICP value was compared between the two groups at the first 12 h, 24 h, 48 h, 72 h after came to the hospital. Meanwhile, the relevance of ICP and Glasgow coma Score(GCS), acute physiology, chronic health evaluation(APACHEⅡ)or latency of FVEP wave were explored.Results Amount of bleeding in survival patients, blood bombs value, WBC and midline shift were significantly lower than death group(P<0.05). The ICP values of survival group were significantly lower than the death group at 12 h, 24 h, 48 h and 72 h(P<0.05). The GCS scores of the survival group were significantly higher than the death group(P<0.05)at 12 h. At the same time, APACHEⅡ score and FVEP each wave latency(P2, N2, P3, N3)of survival group were significantly lower than the death group(P<0.05). ICP monitored values and GCS score have a negative correlation(P<0.05)in HICH patients, but showed a significant positive correlation to APACHEⅡ score and FVEP each wave latency(P2, N2, P3, N3)(P<0.05).Conclusion The ICP values of HICH patient could closely reflect the severity of disease, the prognosis of the patient, for the clinical treatment has a certain value.