破裂脑动脉瘤不同时机夹闭术后的颅内压监测研究

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摘要目的探讨破裂脑动脉瘤不同时机夹闭术后患者的颅内压（ICP）变化特点。方法回顾性分析2014年10月～2016年9月我院收治的满足纳入和排除标准的49例成人破裂脑动脉瘤患者的临床资料，按照动脉瘤夹闭手术时间分为早期（发病≤3 d）手术组（26例）和延迟（发病4～21 d）手术组（23例），两组均在术后行持续ICP 监测及以ICP为导向的综合治疗。比较、分析两组患者术后ICP变化特点及其临床意义。以随访12个月的死亡率和改良Rankin量表（mRS）评分评价两组患者的预后。结果两组患者的影像学特征方面、预后情况比较，差异无统计学意义（P>0.05）。早期手术组患者术后ICP 总体平均值为（15.21±3.71）mmHg，高于延迟手术组的（14.12±4.13）mmHg，差异有统计学意义（P<0.05）。早期手术组患者术后ICP平均值呈现先缓慢增高而后下降的趋势，术后第3、5天均高于术后第1天，其中以术后第5天最高，而术后第7天则降低，且低于术后第1天，差异有统计学意义（P<0.05）；延迟手术组患者术后第2天ICP平均值增高之后即开始下降，术后第6、7天均低于术后第1天，其中以术后第7天为最低，差异有统计学意义（P<0.05）；两组患者术后第7天的ICP平均值比较，差异无统计学意义（P>0.05）。结论发病3 d 内早期手术的破裂脑动脉瘤患者术后总体ICP 高于延迟手术组。早期手术和延迟手术术后ICP 均呈先增高而后下降的趋势，早期手术最高峰在第5天，而延迟手术术后第2天最高。两种手术时机术后患者的ICP 在经过治疗后均能够下降至较低水平。这一规律有助于破裂脑动脉瘤术后ICP增高临床诊疗策略的制定。

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	许雅纹
	方文华
	蔡嘉伟
	王芳玉
	林章雅
	林元相
	余良宏
	康德智

关键词 ：脑动脉瘤, 蛛网膜下腔出血, 颅内压监测, 预后

Abstract：Objective To explore the characteristics of intracranial pressure (ICP) in patients after ruptured cerebral aneurysms clipped at different timing.Methods The clinical data of 49 adult patients with ruptured cerebral aneurysm in our hospital who met the inclusion and exclusion criteria from October 2014 to September 2016 were retrospectively analyzed.They were divided into the early surgery (≤3 days after onset)group (26 cases) and delayed surgery (4-21 days after onset) group (23 cases) according to the timing of clipping.The continuous ICP monitoring and ICP-oriented comprehensive treatment were performed after surgery in both groups.The characteristics and clinical significance of postoperative ICP of patients in two groups were compared and analyzed.The prognosis of the patients in two groups was evaluated by mortality and modified Rankin scale (mRS) score at 12-month follow-up.Results There were no significant differences in imaging characteristics and prognosis between the two groups of patients (P>0.05).The total average postoperative ICP of patients in the early surgery group was (15.21±3.71) mmHg, which was higher than that in the delayed surgery group for (14.12±4.13) mmHg, and the difference was statistically significant (P<0.05).The average postoperative ICP of patients in the early surgery group increased slowly and then decreased, average ICP on the third and fifth days after surgery was higher than that at the first day, with the highest on the fifth day and it decreased on the seventh day after surgery, and was lower than that on the first day after surgery, with statistically significant differences (P<0.05).In the delayed surgery group, the average ICP started to decrease on the second day after surgery, and the average ICP on the sixth and seventh days after surgery was lower than that on the first day, lowest on the seventh day after surgery, with statistically significant differences (P<0.05).There was no significant difference in the average ICP between the two groups on the seventh day after surgery (P>0.05).Conclusion The total postoperative ICP of patients with ruptured cerebral aneurysm who have been operated within 3 days after onset is higher than that of delayed surgery.The postoperative ICP of patients with either early or delayed surgery shows a tendency of increasing first and decreasing then.The ICP reaches the peak on the fifth day after early surgery while that on the second day after delayed surgery.The ICP of patients after clipping at different timing can be reduced to a lower level after treatment.This feature may be helpful for the clinical diagnosis and treatment of increased postoperative ICP in patients with ruptured cerebral aneurysm.

Key words： Cerebral aneurysm Subarachnoid hemorrhage Intracranial pressure monitoring Prognosis

基金资助:福建省科技计划引导性项目（2017Y0032）；福建医科大学启航基金项目（2016QH060）

通讯作者: 方文华（1982-），男，博士，副主任医师，主要从事神经创伤与神经重症的基础与临床研究

引用本文:

许雅纹；方文华；蔡嘉伟；王芳玉；林章雅；林元相；余良宏；康德智. 破裂脑动脉瘤不同时机夹闭术后的颅内压监测研究[J]. 中国当代医药, 2020, 27(12): 4-7转28.
XU Ya-wen； FANG Wen-hua； CAI Jia-wei ； WANG Fang-yu； LIN Zhang-ya； LIN Yuan-xiang； YU Liang-hong； KANG De-zhi. Study on intracranial pressure monitoring after ruptured cerebral aneurysm clipped at different timing. 中国当代医药, 2020, 27(12): 4-7转28.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2020/V27/I12/4

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