不同位置颅内压监测在自发性脑内血肿中的对比研究

发布时间：2018-03-22 21:30

本文选题：颅内压　切入点：脑内血肿　出处：《苏州大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的探讨颅内压监测在自发性脑内血肿患者治疗中的应用价值，通过对同侧大脑半球及双侧脑室在有脑出血所致占位效应的情况下，比较分析颅内压监测数值变化情况，为自发性脑内出血的颅内压监测及临床治疗提供参考。方法选择2011年3月至2013年3月，长宁区中心医院神经外科收治的自发性脑出血患者120例。将患者随机分为监测组和非监测组。在监测组内又根据颅内血肿的位置：以脑实质为主分为监测组1；以脑室出血为主分为监测组2，分别进行颅内血肿穿刺术。比较分析监测组和非监测组患者术后3个月预后情况（GOS评价）、术后并发症的发生情况、脱水剂使用量以及住院时间。同时比较监测组患者不同位置颅内压的变化情况。结果与非监测组患者44.4%相比，监测组患者预后良好比率明显提高，可达78.33%，预后重残及死亡比率明显下降，均为5.00%。与非监测组患者相比，监测组患者甘露醇脱水剂的使用量明显减少，平均住院时间明显缩短。与非监测组患者相比，监测组患者术后电解质紊乱及肾功能损害等并发症的发生率均明显下降，，分别为18.33%和1.67%，差异均具有统计学意义（P＜0.05）。通过对监测组1及监测组2术中的颅内压数值的观察，硬膜下0cm硬膜下1cm硬膜下2cm硬膜下3cm硬膜下4cm硬膜下5cm，颅内压数值呈现逐步上升的趋势，存在明显的梯度变化。对监测组2的颅内压数值的变化情况显示，占位效应处脑组织压力非占位处脑组织的压力。在甘露醇使用前后各30min，颅内压的情况均表现为：占位效应处脑组织压力非占位处脑组织压力，且二者之间呈现一定的梯度变化。且随着尿激酶注射量的增加（颅内占位效应的增加）双侧颅内压均呈现上升趋势并存在明显的梯度关系。随着颅内血肿的减少（颅内占位效应的减少），二者出现下降趋势但仍存在一定的梯度变化，差异具有统计学意义（P＜0.05）。结论颅内压监测能够指导临床合理应用降颅压药物，对降低药物不良反应的发生，改善患者的预后具有十分重要的意义。同时，自发性脑出血后颅腔不同部位的压力是不相同的，存在一定的压力梯度的变化，并且颅内压力梯度是从占位效应处向外不断减小。脑内血肿患者行颅内压监测时探头应尽可能放置在血肿内或其附近，这样更有助于临床上判断病情变化，为治疗提供准确的参考。
[Abstract]:Objective to explore the value of intracranial pressure monitoring in the treatment of patients with spontaneous intracerebral hematoma. To provide reference for intracranial pressure monitoring and clinical treatment of spontaneous intracerebral hemorrhage. Methods from March 2011 to March 2013, 120 cases of spontaneous intracerebral hemorrhage were randomly divided into monitoring group and non-monitoring group. According to the location of intracranial hematoma in the monitoring group, cerebral parenchyma was divided into monitoring group (1) and monitoring group (1) according to the location of intracranial hematoma. Intracerebroventricular hemorrhage was divided into monitoring group (2) and intracranial hematoma puncture respectively. The prognosis of the patients in the monitoring group and the non-monitoring group were compared and GOS was used to evaluate the postoperative complications. The amount of dehydrating agent and the length of stay were also compared between the monitoring group and the monitoring group. Results compared with the non-monitoring group (44.4%), the rate of good prognosis in the monitoring group was 78.33, and the ratio of severe disability and death was 5.000.Compared with that of the non-monitoring group, the prognosis of the patients in the monitoring group was significantly higher than that in the control group. The use of mannitol dehydrating agent in the monitoring group was significantly reduced, and the average hospitalization time was shortened. Compared with the non-monitoring group, the incidence of complications such as electrolyte disturbance and renal dysfunction in the monitoring group were significantly decreased. The difference was statistically significant (P < 0.05). The Intracranial pressure in Group 1 and Group 2 was observed. Subdural 0cm subdural 1cm subdural 2cm subdural 2cm subdural 4cm subdural 5 cm, intracranial pressure values showed a gradual upward trend, there was a significant gradient change. The pressure of brain tissue in the space occupying effect was not the pressure of the brain tissue in the space occupying place. 30 minutes before and after mannitol use, the intracranial pressure was: the pressure of the brain tissue in the space occupying effect, the pressure of the brain tissue in the non-occupying place, the pressure of the brain tissue in the non-occupying place. With the increase of urokinase injection (intracranial occupying effect), the bilateral intracranial pressure showed an upward trend and there was a significant gradient relationship with the decrease of intracranial hematoma. (the decrease of intracranial space occupying effect, both of them have a downward trend, but there is still a certain gradient change, The difference was statistically significant (P < 0.05). Conclusion Intracranial pressure monitoring can guide the rational use of intracranial pressure drugs in clinical practice, and it is of great significance to reduce the occurrence of adverse drug reactions and improve the prognosis of patients. After spontaneous intracerebral hemorrhage, the pressure in different parts of the cranial cavity is different, and there is a change of pressure gradient. The intracranial pressure gradient is decreasing from the space occupying effect to the outside. The probe should be placed in or near the intracranial hematoma in patients with intracerebral hematoma as much as possible, which is helpful to judge the change of the disease in clinic. To provide accurate reference for treatment.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.34

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