上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

颅内压监测在破裂颅内动脉瘤夹闭手术中的应用

张珏，费智敏，书国伟，王静予，蔡佩浩，邱锋，许乐宜，孔令军，龚立，谭晓辉，于淼，马佳涛   

  1. 上海中医药大学附属曙光医院神经外科， 上海 201203
  • 出版日期:2015-05-28 发布日期:2015-06-04
  • 通讯作者: 费智敏, 电子信箱: tommyfei@126.com。
  • 作者简介:张珏（1979—）， 男， 主治医师， 硕士; 电子信箱: zhangjue_sunrun@hotmail.com。
  • 基金资助:

    上海市教委课题(13ZZ094）；上海市中医药事业发展三年行动计划（ZYSNXD012-RC-ZXY001）；上海高校青年教师培养资助计划（Zzszy13025）

Application of intracranial-pressure monitoring for ruptured intracranial aneurysm clipping operations

ZHANG Jue, FEI Zhi-min, SHU Guo-wei, WANG Jing-yu, CAI Pei-hao, QIU Feng, XU Le-yi, KONG Ling-jun, GONG Li, TAN Xiao-hui, YU Miao, MA Jia-tao   

  1. Department of Neurosurgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203， China
  • Online:2015-05-28 Published:2015-06-04
  • Supported by:

    Shanghai Municipal Education Commision Project，13ZZ094；Project of Three Years for the Development of Shanghai Traditional Chinese Medicine Career， ZYSNXD012-RC-ZXY001； Young Teacher Training Project of Shanghai Colleges and Universities， Zzszy13025

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摘要：

目的 探讨颅内压监测在破裂颅内动脉瘤夹闭手术中的应用价值。方法 57例破裂动脉瘤患者开颅手术夹闭术中植入基本型或脑室导管型颅内压监测探头，术后根据颅内压监测指导药物治疗和脑脊液引流。对患者预后及并发症发生情况进行分析。结果 42例患者术后颅内压始终低于20 mmHg （1 mmHg=0.133 kPa）；13例患者根据颅内压监测结果给予甘露醇脱水，增加脑脊液引流后颅内压低于20 mmHg；1例脑内血肿患者通过二次手术治疗后好转；1例大面积梗死患者死亡。术后随访3~6个月，CT检查发现11例（19.3％）患者存在不同程度脑积水，放置脑室导管型颅内压探头患者脑积水的发生率为15.22%，显著低于放置基本型颅内压探头患者的36.36%（P<0.05）。结论 颅内压监测，特别是脑室导管型颅内压监测可以观察破裂动脉瘤夹闭术后病情变化，指导治疗，减少并发症的发生。

关键词: 颅内压监测, 动脉瘤夹闭, 脑积水

Abstract:

Objective To explore the application value of intracranial-pressure (ICP) monitoring for ruptured intracranial aneurysm clipping operations. Methods A total of 57 patients with ruptured intracranial aneurysm underwent the clipping operation with ICP monitoring (basic or venticular catheter kit) implanted. The post-operative drug treatment and cerebral-spinal fluid (CSF) drainage were based on the ICP monitoring. The prognosis and complications of patients were analyzed.  Results The post-operative ICP of 42 patients was constantly below 20 mmHg (1 mmHg=0.133 kPa). Thirteen patients underwent mannitol treatment and CSF drainage according to the results of ICP monitoring and their ICPs maintained below 20 mmHg. One patient with intra-cerebral haematoma underwent a second operation and the symptoms were relieved. One patient with serious infarction died. Patients were followed up for 3-6 months after operation. CT examinations showed that there were 11 patients (19.3％) with different degrees of hydrocephalus. The incidence of hydrocephalus of patients who implanted the venticular catheter kit was 15.22%, which was significantly lower than that (36.36%) of patients who implanted the basic catheter kit (P<0.05). Conclusion ICP monitoring, especially the venticular catheter kit, can monitor the post-operative condition of ruptured intracranial aneurysm clipping operation, guide the treatment, and reduce complications.

Key words: intracranial-pressure monitoring, aneurysm clipping, hydrocephalus