黄培根　吴光辉　蔡智基

[摘要] 目的 對颅内血肿术后颅内压监测的临床应用进行研究，以期为颅内血肿术后治疗提供一定的参考依据。 方法 方便选取2010年2月—2016年6月该院接受治疗的42 例颅内血肿术后患者为研究对象，对其实施持续动态颅内压监测，以监测结果为依据，对临床治疗进行指导，并对其临床治疗效果进行记录与分析。结果 术后12 h恢复正常的有9 例， 其ICP 为（10±3.0）mmHg ；表现为轻度增高的有23例，其 ICP 为（15±1.0） mmHg；表现为中度增高的有8 例，其 ICP 为（25±1.5）mmHg ；表现为重度增高的有2 例， ICP 均超过42 mmHg 。24 h 后所有患者的颅内压均出现不同程度增高情况。42 例患者在颅内压监测结果的指导下，32例正常或轻度增高者通过减少脱水剂用量进行治疗，10例中重度增高者则及时采取了加大脱水剂或再次手术等处理，均取得良好的临床治疗效果。患者治疗前的格拉斯哥昏迷评分为（6.07±1.01）分，经过治疗后，患者的格拉斯哥昏迷评分为（11.67±2.78）分，患者治疗后的格拉斯哥昏迷评分明显高于治疗前，差异有统计学意义（P<0.05）。脱水治疗甘露醇使用剂量为（496.98±42.72）mL，无患者未出现颅内感染情况。结论 持续动态ICP 监测在颅内血肿术后的临床处理上有重要指导意义，具有较高的临床应用价值及推广价值。

[关键词] 颅内压监测；颅内血肿术后；治疗

[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742（2017）08（a）-0105-03

[Abstracts] Objective This paper tries to study the clinical application of intracranial pressure monitoring after intracranial hematoma， so as to provide some reference for postoperative treatment of intracranial hematoma. Methods 42 patients with intracranial hematoma were treated in this hospital from February 2010 to June 2016 were convenient selected and treated with continuous dynamic intracranial pressure monitoring. Guidance was given according to the results， and its clinical treatment effect was recorded and analyzed. Results 9 cases were recovered after 12 hours operation， the ICP was（10±3.0） mmHg； 23 cases were mildly increased， with the ICP of （15±1.0） mmHg and 8 cases were moderately increased， with the ICP of（25±1.5） mmHg； 2 cases showed severe increase， with the ICP more than 42mmHg. Intracranial pressure were increased to varying degrees of all patients after 24 hours. Under the guidance of the results of intracranial pressure monitoring， 32 cases of the total 42 cases presented normal or mild increase adopted dehydration treatment， 10 cases of moderate and severe increase timely increased dehydration or re-surgery and other treatment， all of which achieved good clinical results. The patients Glasgow coma score before treatment was（6.07±1.01）points，（11.67±2.78）points after treatment， the Glasgow coma score after treatment was significantly higher than before， the difference was statistically significant（P<0.05）. Dehydration treatment mannitol dose was（496.98±42.72） mL， no case of patients were without intracranial infection. Conclusion Continuous dynamic monitoring of ICP has important guiding significance in the clinical treatment of intracranial hematoma， and it has high clinical application and popularization value.

[Key words] Intracranial pressure monitoring； Intracranial hematoma postoperative； Treatment

颅内压（ICP）指的是颅腔内脑脊液的压力，正常情况下是100～150 mm H2O，10～15 mmHg[1]。颅内压增高是临床上一种比较常见的神经外科病理综合征，颅内压增高患者多伴有脑积水、颅脑外伤、出血及脑积水等症状[2]。颅内压增高极易诱发脑疝危象，情况严重时还有可能导致患者出现呼吸循环衰竭症状，危及患者的生命安全。所以，探寻一种有效的颅内压监测及治疗办法就显得尤为重要。……