实时、持续无创颅内压监测在高血压脑出血治疗中的应用价值

高明霞　黄国权　李仲展

【摘要】 目的：探討闪光视觉诱发电位对无创颅内压（noninvasive intracranial pressure，NICP）和脑灌注压（cerebral perfusion pressure，CPP）变化监测在治疗高血压脑出血中的应用价值。方法：本研究纳入2014年1月-2016年12月就诊于本院ICU的高血压脑出血患者80例，采用随机数字表法1∶1对照将患者分为试验组和对照组，各40例。对照组给予常规治疗，试验组在闪光视觉诱发电位监测无创颅内压和脑灌注压情况下进行脑出血的治疗，比较两组患者的治疗效果。结果：与治疗前比较，两组患者治疗后的颅内压均下降，脑灌注压均升高（P<0.05），试验组变化均较对照组更为明显（t=-3.652、6.349，P=0.001、0.001）。试验组患者的甘露醇使用量明显低于对照组，差异有统计学意义（t=-15.921，P=0.001）。试验组的治愈率为70.0%，高于对照组的47.5%，差异有统计学意义（ 字2=4.178，P=0.034）。结论：闪光视觉诱发电位可以对高血压脑出血患者进行实时、持续的无创监测，并指导临床用药，可以有效提高治愈率，具有临床应用和推广价值。

【关键词】 高血压脑出血； 闪光视觉诱发电位； 无创颅内压； 脑灌注压； 监测

Application Value of Real-time and Continuous Non-invasive Intracranial Pressure Monitoring in the Treatment of Hypertensive Intracerebral Hemorrhage/GAO Mingxia，HUANG Guoquan，LI Zhongzhan，et al.//Medical Innovation of China，2018，15（03）：024-027

【Abstract】 Objective：To investigate the application value of flash visual evoked potential in the monitoring of the noninvasive intracranial pressure and cerebral perfusion pressure for patients with hypertensive intracerebral hemorrhage.Method：80 hypertensive cerebral hemorrhage patients treated from January 2014 to December 2016 in our ICU department were selected，the patients were divided into experimental group and control group by 1∶1 random digital table method，40 cases in each group.The control group adopted the conventional therapy，the experimental group adopted the flash visual evoked potential to monitor the intracranial pressure and cerebral perfusion pressure，the clinical effect of the two groups were compared.Result：Compared with pretreatment，the intracranial pressure of both groups decreased and the cerebral perfusion pressure of both groups increased（P<0.05），the changes in the experimental group were more obvious than those in the control group （t=-3.652，6.349；P=0.001，0.001）.The amount of Mannitol used in the experimental group was significantly lower than that of the control group，and the difference was statistically significant（t=-15.921，P=0.001）.The cure rate of the experimental group was 70.0%，which was higher than 47.5% of the control group，the difference was statistically significant（ 字2=4.178，P=0.034）.Conclusion：The flash visual evoked potential can be used for real-time and continuous noninvasive monitoring of hypertensive cerebral hemorrhage patients，and the clinical application can be guided，so that the curative rate can be effectively improved，and the method has clinical application and popularization value.

【Key words】 Hypertensive intracerebral hemorrhage； Flash visual evoked potential； Noninvasive intracranial pressure； Cerebral perfusion pressure； Monitoring

First-authors address：Zhaoqing First Peoples Hospital，Zhaoqing 526000，China

doi：10.3969/j.issn.1674-4985.2018.03.006

高血压性脑出血属于急性脑血管疾病，是由急性脑循环障碍所致的局限或全面性脑功能缺损，是严重危害人群健康的常见病、多发病，具有发病迅速、病情严重、变化快、病死率高、致残率高等特点[1]。而颅内压（intracranial pressure，ICP）增高及其引发的脑灌注压（cerebral perfusion pressure，CPP）降低是高血压性脑出血后导致患者神经功能致残，甚至死亡的重要原因，因此及时掌握颅内压和脑灌注压力变化，并根据病情变化迅速调整治疗方案是危重患者抢救成功的关键[2]。颅内压监测为高血压性脑出血的诊断、治疗及预后提供最直接的临床依据，尤其在解决神经科疑难症、急重症颅内高压症的治疗过程中提供指导依据。传统的颅内压实时监测主要采取开颅监测和腰穿监测，但以上两种有创操作方式具有过程繁琐、耗材昂贵，且有10%～25%的概率导致颅内感染、颅内出血或脑脊液漏等问题；……