颅内动脉瘤夹闭术后颅内压监测临床价值的探讨

王亮亮; 何朝晖; 朱继; 张晓冬; 郭宗铎; 廖正步; 夏永智; 孙晓川

doi:10.13406/j.cnki.cyxb.000797

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颅内动脉瘤夹闭术后颅内压监测临床价值的探讨

临床研究 | 更新时间：2024-01-17

- 颅内动脉瘤夹闭术后颅内压监测临床价值的探讨
- Clinical value of intracranial pressure monitoring after clipping of intracranial aneurysm
- 重庆医科大学学报 2015年40卷第12期页码：1541-1545
- 作者机构：
  
  重庆医科大学附属第一医院神经外科
- 作者简介：
- 基金信息：
  
  国家临床重点专科建设经费资助项目（编号:社财[2011]170号）
- DOI：10.13406/j.cnki.cyxb.000797
  中图分类号： R651.12
- 纸质出版日期：2015，
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[1]王亮亮,何朝晖,朱继,张晓冬,郭宗铎,廖正步,夏永智,孙晓川.颅内动脉瘤夹闭术后颅内压监测临床价值的探讨[J].重庆医科大学学报,2015,40(12):1541-1545.

Wang Liangliang, He Zhaohui, Zhu Ji, et al. Clinical value of intracranial pressure monitoring after clipping of intracranial aneurysm[J]. Journal of Chongqing Medical University, 2015,40(12):1541-1545.
[1]王亮亮,何朝晖,朱继,张晓冬,郭宗铎,廖正步,夏永智,孙晓川.颅内动脉瘤夹闭术后颅内压监测临床价值的探讨[J].重庆医科大学学报,2015,40(12):1541-1545. DOI： 10.13406/j.cnki.cyxb.000797.

Wang Liangliang, He Zhaohui, Zhu Ji, et al. Clinical value of intracranial pressure monitoring after clipping of intracranial aneurysm[J]. Journal of Chongqing Medical University, 2015,40(12):1541-1545. DOI： 10.13406/j.cnki.cyxb.000797.

摘要

目的:观察颅内动脉瘤夹闭术后颅内压（intracranial pressure

ICP）的变化规律

以探讨ICP监测在临床治疗的价值。方法:回顾性分析88例前循环动脉瘤患者动脉瘤术后ICP变化规律与临床分级（Hunt-Hess分级及世界神经外科医师联盟（WFNS）分级）、Fisher分级、格拉斯哥昏迷评分（Glasgow coma score

GCS）、格拉斯哥预后评分（Glasgow outcome score

GOS）及影像学等因素的关系。结果:（1）ICP监测值与Hunt-Hess分级（P<0.01）、WFNS分级（P=0.007）、Fisher分级（P=0.006）、ICP增高时GCS（P=0.001）、术后影像学改变（P=0.010）、基底池情况（P=0.039）、中线移位（P=0.007）、术后6个月的GOS（P=0.031）存在相关性;（2）有少数（12例

13%）患者出现意识障碍加深、影像学提示术区血肿、中线移位、基底池受压等改变

但ICP始终正常。结论:动脉瘤性蛛网膜下腔出血患者行动脉瘤夹闭术后需持续动态监测ICP变化

并结合患者临床表现及影像学改变进行综合分析

以提高围手术期的安全性。

Abstract

Objective:To assess the clinical value of intracranial pressure(ICP) monitoring after intracranial aneurysm clipping. Methods:ICP of eighty-eight patients with intracranial aneurysm was continuously monitored for 1-9 d after operation. Relations of ICP level with the preoperative clinical state(Hunt-Hess

WFNS)

image features(compression of basal cistern

midline shift)

postoperative clinical state at the highest intracranial pressure(Glasgow coma score

GCS) and 6 months’ clinical outcome(Glasgow outcome score

GOS) were analyzed. Results:There were strong associations of ICP with Hunt-Hess(P<0.01)

WFNS grading(P=0.007)

Fisher results(P =0.006)

postoperative GCS(P =0.001)

postoperative image(P =0.010)

basal cistern(P =0.039)

midline shift(P =0.007) and GOS at 6 month after the operation(P=0.031). Whereas

13% patient with normal ICP after surgery had worsened clinical presentation

postoperative hematoma or midline shifts. Conclusion :ICP monitoring after aneurysm surgery in subarachnoid hemorrhage patients is benefit in postoperative management

which should be combined with clinical manifestation and imaging study.

关键词

颅内动脉瘤动脉瘤夹闭术颅内压监测蛛网膜下腔出血

Keywords

intracranial aneurysmintracranial aneurysm clippingintracranial pressure monitoringsubarachnoid hemorrhage

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