持续颅内压监测对高血压脑出血治疗中脱水剂使用的指导价值

目的 通过观察持续颅内压(ICP)监测在高血压脑出血(HICH)患者治疗中颅内压的变化,指导脱水剂的运用和调整,分析临床疗效,评价其临床应用价值.方法 选择2014年6月至2016年6月期间本院脑外科收治的高血压脑出血(HIGH)患者86例,按照数字表法随机分为两组,对照组43例给予基础治疗及甘露醇;观察组43例在对照组治疗的基础上行颅内压监测,按照监测数值的变化及时调整甘露醇用量及治疗方案,并比较两组的临床效果.结果 治疗后6个月,观察组良好率为58.14％,显著地高于对照组的32.56％(x2=5.6770,P＜0.05);观察组甘露醇的平均总使用量明显少于对照组(P＜0.05);住院期间观察组电解质紊乱、肺部感染、肾功能损害、应激性溃疡及脑出血复发并发症率均显著地低于对照组(均P＜ 0.05).结论 对于HICH患者,持续ICP监测可以有效地指导脱水剂的灵活运用,并显著地降低并发症发生率,能够明显改善预后,在脑外科为一种较为理想的辅助治疗方法.

Application value of continuous intracranial pressure monitoring in hypertensive intracerebral hemorrhage

Objective To observe the change of intracranial pressure in the treatment of hypertensive intracerebral hemorrhage (HICH) by observing continuous intracranial pressure (ICP),to guide the application and adjustment of dehydrating agent,to analyze the clinical curative effect and evaluate its clinical application value.Methods 86 patients with hypertensive intracerebral hemorrhage (HICH) were enrolled in this study from June 2014 to June 2016.The patients were randomly divided into two groups according to the digital table method.43 patients in the control group were treated with basic therapy and mannitol;43 patients in the observation group received intracranial pressure monitoring on the basis of the control group,adjusting mannitol dosage and treatment options in accordance with the changes of monitoring data.And the clinical effect of the two groups were compared.Results After 6 months of treatment,the good rate of the observation group was 58.14％,and significantly higher than 32.56％ of the control group (x 2=5.6770,P＜0.05).The average total amount of mannitol in the observation group was significantly lower than that in the control group (P＜0.05).The incidences of electrolyte imbalance,pulmonary infection,renal dysfunction,stress ulcer,and recurrent cerebral hemorrhage in the observation group in the duration of hospital stay were significantly lower than those in the control group (P＜0.05).Conclusion In patients with HICH,continuous ICP monitoring can effectively guide the flexible use of dehydrating agent,significantly reduce the incidence of complications,significantly improve the prognosis,which has become a more ideal adjuvant therapy in the cerebral surgery.