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目的探讨小骨窗开颅手术治疗幕上高血压脑出血患者术后进行持续动态颅内压(intracranial pressure,ICP)监护的临床价值。方法采用脑实质内ICP监护法对19例小骨窗开颅的幕上高血压脑出血患者(2009年1月至2010年12月重庆医科大学附属第一医院神经外科住院患者)进行术后ICP动态监护。选取2008年1-12月该科11例小骨窗开颅手术患者作为对照(既往常规经验治疗组)。结果本组4例重度ICP增高患者在开始出现颅高压时仅2例有症状和体征,1例死亡。ICP监护组20%甘露醇应用天数为(8±3)d,剂量为(925±125)g;既往常规经验治疗组20%甘露醇应用天数为(11±4)d,剂量为(1475±175)g。ICP监护组20%甘露醇应用时间及剂量均明显低于既往常规经验治疗组(P<0.05)。结论脑实质内ICP持续监护有助于对小骨窗开颅治疗幕上高血压脑出血患者病情变化的及时、准确判断,可为疾病的早期、正确治疗提供可靠的依据。
Objective To investigate the clinical value of craniotomy for the treatment of patients with supratentorial hypertensive intracerebral hemorrhage undergoing continuous dynamic intracranial pressure (ICP) monitoring. Methods The intracranial ICP monitoring method was used to analyze the postoperative ICP status of 19 patients with supratentorial intracerebral hemorrhage (January 2009 to December 2010, Department of Neurosurgery, First Affiliated Hospital of Chongqing Medical University) guardianship. Eleven patients with small craniotomy underwent craniotomy in the department from January to December in 2008 as the control group (conventional experience-treated group). Results In this study, 4 patients with severe ICP increased their symptoms and signs in only 2 cases and 1 died when they began to have intracranial hypertension. The number of days of 20% mannitol administration was (8 ± 3) days and the dosage was (925 ± 125) g in the ICP monitoring group. The number of days of 20% mannitol administration was 11 ± 4 days and 1475 ± 175) g. The application time and dosage of 20% mannitol in ICP monitoring group were significantly lower than those of conventional experience treatment group (P <0.05). Conclusion Intra-parenchymal intracranial ICP monitoring is helpful to timely and accurately judge the changes of patients with supratentorial intracerebral hemorrhage in the treatment of supratentorial hypertensive intracerebral hemorrhage. It can provide a reliable basis for the early and correct treatment of the disease.