颅内动脉瘤夹闭术后颅内压波形参数的临床价值

李辉; 黄志坚; 文毫; 漆凌骏; 刘国静; 柴伟娜; 徐丹; 杨小敏; 孙晓川

doi:10.16016/j.1000-5404.201711139

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颅内动脉瘤夹闭术后颅内压波形参数的临床价值

临床医学 | 更新时间：2026-01-09

- 颅内动脉瘤夹闭术后颅内压波形参数的临床价值
- Clinical value of intracranial pressure wave parameters in patients after intracranial aneurysm clipping
- 第三军医大学学报 2018年40卷第7期页码：631-635
- 作者机构：
  
  1.400016 重庆，重庆医科大学附属第一医院神经外科
  2.400044 重庆，重庆大学物理学院
- 作者简介：
  
  [孙晓川，E-mail:sunxch1445@qq.com SUN Xiaochuan, E-mail: sunxch1445@qq.com
- 基金信息：
  
  国家自然科学基金面上项目(81571159);国家临床重点专科建设经费资助((2011)170)
- DOI：10.16016/j.1000-5404.201711139
  中图分类号： R181.32;R741.044;R743.9
- 收稿：2017-11-17，
  
  修回：2018-01-07，
  
  纸质出版：2018-04-15
- 稿件说明：
移动端阅览
李辉, 黄志坚, 文毫, 等. 颅内动脉瘤夹闭术后颅内压波形参数的临床价值[J]. 第三军医大学学报, 2018,40(7):631-635.

Hui LI, Zhijian HUANG, Hao WEN, et al. Clinical value of intracranial pressure wave parameters in patients after intracranial aneurysm clipping[J]. Journal of Third Military Medical University, 2018, 40(7): 631-635.
李辉, 黄志坚, 文毫, 等. 颅内动脉瘤夹闭术后颅内压波形参数的临床价值[J]. 第三军医大学学报, 2018,40(7):631-635. DOI： 10.16016/j.1000-5404.201711139.

Hui LI, Zhijian HUANG, Hao WEN, et al. Clinical value of intracranial pressure wave parameters in patients after intracranial aneurysm clipping[J]. Journal of Third Military Medical University, 2018, 40(7): 631-635. DOI： 10.16016/j.1000-5404.201711139.

摘要

目的

分析颅内压波形参数与患者术后早期临床表现的相关性，探讨颅内动脉瘤夹闭术后颅内压波形参数的临床价值。

方法

收集2016年11月至2017年7月重庆医科大学附属第一医院神经外科重症监护室颅内动脉瘤夹闭术后使用颅内压(intracranial pressure，ICP)监测的55例患者的临床资料。根据患者ICP植入术后24 h内的ICP数据，使用领域平均振幅算法计算2个ICP波形参数：平均ICP值(mean intracranial pressure，MICP)和平均ICP振幅值(mean intracranial pressure wave amplitude，MWA)。分析MICP、MWA与患者术前病情及术后早期临床表现的关系。

结果

① 患者术前病情较轻者，其术后MICP、MWA越低。②根据术后格拉斯哥评分(glasgow coma score，GCS)将患者分为3组(GCS 3~8分，GCS 9~12分，GCS 13~15分)，各组间MICP和MWA差异均有统计学意义(

0.05)。③术后GCS评分与MICP(

=-0.619，

0.05)、MWA(

=-0.782，

0.05)呈负相关，且MWA与GCS评分相关性更强。

结论

ICP波形参数MICP、MWA能有效地反映颅内动脉瘤夹闭术后早期患者的神经功能障碍。

Abstract

Objective

To analyze the correlation between the parameters of intracranial pressure wave and early clinical manifestations in the patients after intracranial aneurysm clipping

and investigate the clinical value of these parameters.

Methods

Clinical data of 55 patients with full data on intracranial pressure (ICP) after intracranial aneurysm clipping in our neurosurgical department from November 2016 to July 2017 were collected in this study. According to the ICP results within 24 h after implantation

2 ICP parameters

mean intracranial pressure (MICP) and mean intracranial pressure wave amplitude (MWA) were calculated by area average amplitude algorithm. The correlations of MICP and MWA with the preoperative conditions and postoperative clinical manifestations were analyzed.

Results

① For the patients with milder preoperative conditions

they had lower MICP and MWA after operation. ②When the patients were divided into 3 groups based on Glasgow coma score (GCS

3~8

9~12 and 13~15 points respectively)

significant differences were seen in MWA and MICP among different GCS groups (

0.05). ③There were negative correlation of postoperative GCS score with MICP (

=-0.619

0.05) and MWA (

=-0.782

0.05)

with MWA more significant.

Conclusion

ICP wave parameters

MWA and MICP

both can effectively indicate early nervous dysfunction in patients after intracranial aneurysm clipping.

关键词

Keywords

references

LAVINIO A, MENON D K.Intracranial pressure: why we monitor it, how to monitor it, what to do with the number and what's the future?[J].Curr Opin Anaesthesiol, 2011, 24(2): 117-123. DOI:10.1097/ACO.0b013e32834458c5.

徐跃峤, 王宁, 胡锦, 等.重症动脉瘤性蛛网膜下腔出血管理专家共识(2015)[J].中国脑血管病杂志, 2015, 12(4): 215-225. DOI:10.3969/j.issn.1672-5921.2015.04.011.

XU Y Q, WANG N, HU J, et al . Expert consensus on management of severe aneurysmal subarachnoid hemorrhage (2015)[J ] . Chin J Cerebrovasc Dis, 2015, 12(4): 215-225. DOI:10.3969/j.issn.1672-5921.2015.04.011.

罗泽彬, 钟东, 唐文渊, 等.脑实质内颅内压监护在小骨窗开颅治疗幕上高血压脑出血患者中的应用[J].第三军医大学学报, 2011, 33(12): 1293-1295.

LUO Z B, ZHONG D, TANG W Y, et al . Application of intracranial pressure monitoring in treatment of hypertensive supra-tentorial hemorr hage patients with small skull window craniotomy[J ] . J Third Mil Med Univ, 2011, 33(12): 1293-1295.

吴翔, 高国一, 陈文劲, 等.颅脑创伤患者颅内压波形中纺锤波的意义[J].中华神经外科杂志, 2017, 33(7):660-664. DOI:10.3760/cma.j.issn.1001-2346.2017.07.004.

WU X, GAO G Y, CHEN W J, et al . Clinical significance of spindle waves in intracranial pressure monitoring for patients with traumatic brain injury[J ] . Chin J Neurosurg, 2017, 33(7): 660-664. DOI:10.3760/cma.j.issn.1001-2346.2017.07.004.

EIDE P K, SORTEBERG W. Association among intracranial compliance, intracranial pulse pressure amplitude and intracranial pressure in patients with intracranial bleeds[J]. Neurol Res, 2007, 29(8): 798-802. DOI:10.1179/016164107X224132.

CZOSNYKA M, CITERIO G. Brain compliance: the old story with a new "et cetera"[J]. Intensive Care Med, 2012, 38(6): 925-927. DOI:10.1007/s00134-012-2572-6.

CHOPP M, PORTNOY H D. Systems analysis of intracranial pressure. Comparison with volume-pressure test and CSF-pulse amplitude analysis[J]. J Neurosurg, 1980, 53(4): 516-527. DOI:10.3171/jns.1980.53.4.0516.

CARRERA E, K IM D J, CASTELLANI G, et al . What shapes pulse amplitude of intracranial pressure[J ] . J Neurotrauma, 2010, 27(2): 317-324. DOI:10.1089/neu.2009.0951.

EIDE P K, BREAN A. Intracranial pulse pressure amplitude levels determined during preoperative assessment of subjects with possible idiopathic normal pressure hydrocephalus[J]. Acta Neurochirurgica, 2006, 148(11): 1151-1156.DOI:10.1007/s00701-006-0896-0.

MAHFOUD F, BECK J, RAABE A. Intracranial pressure pulse amplitude during changes in head elevation: a new parameter for determining optimum cerebral perfusion pressure[J]. Acta Neurochir (Wien), 2010, 152(3): 443-450. DOI:10.1007/s00701-009-0520-1.

MACKEY J, KHOURY J C, ALWELL K, et al . Stable incidence but declining case-fatality rates of subarachnoid hemorrhage in a population[J ] .Neurology, 2016, 87(21): 2192-2197. DOI:10.1212/WNL.0000000000003353.

王亮亮, 何朝晖, 朱继, 等.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 L L, HE Z H, ZHU J, et al .Clinical value of intracranial pressure monitoring after intracranial aneurysm clipping[J ] . J Chongqing Med Univ, 2015, 40(12):1541-1545.

HEUER G G, SMITH MJ, ELLIOTT JP, etal.Relationship between intracranial pressure and other clinical variables in patients with aneurysmal subarachnoid hemorrhage[J]. J Neurosurg, 2004, 101(3): 408-416. DOI:10.3171/jns.2004.101.3.0408.

CZOSNYKA M, SMIELEWSKI P, TIMOFEEV I, et al . Intracranial pressure: more than a number[J ] .Neurosurg Focus, 2007, 22(5): E10. DOI:10.3171/foc.2007.22.5.11.

DI IEVA A, SCHMITZ E M, CUSIMANO M D.Analysis of intracranial pressure: past, present, and future[J].Neuroscientist, 2013, 19(6): 592-603. DOI:10.1177/10738 58412474845.

BALESTRERI M, CZOSNYKA M, STEINER L A, et al . Intracranial hypertension: what additional information can be derived from ICP waveform after head injury[J ] .Acta Neurochir(Wien), 2004, 146(2): 131-141. DOI:10.1007/s00701-003-0187-y.

EIDE P K, SORTEBERG A, BENTSEN G, et al . Pressure-derived versus pressure wave amplitude-derived indices of cerebrovascular pressure reactivity in relation to early clinical state and 12-month outcome following aneurysmal subarachnoid hemorrhage[J ] .J Neurosurg, 2012, 116(5): 961-971. DOI:10.3171/2012.1.JNS111313.

LANTIGUA H, ORTEGA-GUTIERREZ S, SCHMIDT J M, et al . Subarachnoid hemorrhage: who dies, and why?[J ] Crit Care, 2015, 19: 309. DOI: 10.1186/s13054-015-1036-0.

FUJⅡ M, YAN J, ROLLAND W B, et al . Early brain injury, an evolving frontier in subarachnoid hemorrhage research[J ] . Transl Stroke Res, 2013, 4(4): 432-446. DOI:10.1007/s12975-013-0257-2.

EIDE P K, BENTSEN G, SORTEBERG A G, et al . A randomized and blinded single-center trial comparing the effect of intracranial pressure and intracranial pressure wave amplitude-guided intensive care management on early clinical state and 12-month outcome in patients with aneurysmal subarachnoid hemorrhage[J ] .Neurosurgery, 2011, 69(5): 1105-1115. DOI:10.1227/NEU.0b013e318227e0e1.

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