[1]陈飞亚,梁浩欣,黄好润,等.开颅术后经硬膜下引流管测量颅内压的可行性分析[J].中国临床神经外科杂志,2022,27(10):832-834.[doi:10.13798/j.issn.1009-153X.2022.10.010]
　CHEN Fei-ya,LIANG Hao-xin,HUANG Hao-run,et al.Feasibility analysis of intracranial pressure monitoring after craniotomy through subdural drainage tube[J].,2022,27(10):832-834.[doi:10.13798/j.issn.1009-153X.2022.10.010]
点击复制

开颅术后经硬膜下引流管测量颅内压的可行性分析()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
27
期数:
2022年10期
页码:
832-834
栏目:
论著
出版日期:
2022-10-31

文章信息/Info

Title:
Feasibility analysis of intracranial pressure monitoring after craniotomy through subdural drainage tube
文章编号:
1009-153X（2022）10-0832-03
作者:
陈飞亚; 梁浩欣; 黄好润; 何金燕; 张安; 廖希贤; 邱炳辉; 漆松涛; 包贇; 黄传平
510515广州，南方医科大学南方医院神经外科（陈飞亚、黄好润、张安、廖希贤、邱炳辉、漆松涛、包贇、黄传平）；510515广州，南方医科大学第二临床医学院（梁浩欣、何金燕）
Author(s):
CHEN Fei-ya1;  LIANG Hao-xin1;  HUANG Hao-run1;  ZHANG An1;  LIAO Xi-xian1;  QIU Bing-hui1;  Qi Song-tao1;  BAO Yun1;  HUANG Chuan-ping1
1. Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; 2. The Second School of Clinical Medicine, Southern medical University, Guangzhou 510515, China
关键词:
开颅手术; 颅内压监测; 硬膜下引流管; 液压耦合装置
Keywords:
Craniotomy;  Subdural drainage tube;  Intracranial pressure;  Hydraulic coupling device
分类号:
R651.1+1
DOI:
10.13798/j.issn.1009-153X.2022.10.010
文献标志码:
A
摘要:
目的 探讨开颅术后经硬膜下引流管监测颅内压（ICP）的可行性与效果。方法 2020年1月至2022年8月前瞻性选择开颅手术治疗的病人56例，术中将ICP监测探头置入脑室并使用Codman颅内压监护仪连续监护1周（金标准）；同时，应用液压耦合装置经术后留置硬膜下引流管测量ICP（硬膜下法）。结果 56例金标准测得的ICP[（13.34±5.41）mmHg]与硬膜下法测得的ICP[（14.96±5.33）]无统计学差异（P>0.05）。去骨瓣减压术25例金标准测得的ICP[（13.76±5.14）mmHg]与硬膜下法测得的ICP[（14.68±4.71）mmHg]无统计学差异（P>0.05）。未去骨瓣31例金标准测得的ICP[（13.00±5.66）mmHg]与硬膜下法测得的ICP[（15.03±5.80）mmHg]无统计学差异（P>0.05）。硬膜下法测得的ICP与金标准的差值为（1.6±2.1）mmHg；两种方法测得的ICP呈明显正相关（r=0.892，P<0.001）。术后发生颅内感染1例（1.78%）、颅内少量出血1例（1.78%）。结论 与脑室ICP监测相比，开颅术后使用液压耦合装置经硬膜下引流管可以较为准确地监测ICP，方法简单、经济，易于基层医院推广应用。
Abstract:
Objective To explore the feasibility and accuracy of intracranial pressure (ICP) monitoring through subdural drainage tubeby using hydraulic coupling device after craniotomy. Methods Fifty-six patients with incranial lesion who underwent craniotomy from January 2020 to August 2022 were prospectively selected. ICP monitoring probe was placed into the ventricle during surgery and Codman intracranial pressure monitor was used to monitor ICP for 1 week (gold standard). At the same time, ICP was monitored through subdural drainage tube using hydraulic coupling device (subdural method). Results Of 56 patients, the mean ICP measured by gold standard [(13.34±5.41) mmHg]was not significantly different from the mean ICP measured by subdural method [(14.96±5.33) mmHg; P>0.05]. Of 25 patients receiving decompressive craniectomy, the mean ICP measured by gold standard [(13.76±5.14) mmHg]was not significantly different from the mean ICP measured by subdural method [(14.68±4.71) mmHg; P>0.05]. Of 31 patients without decompressive craniectomy, the mean ICP measured by gold standard [(13.00±5.66) mmHg]was not significantly different from the mean ICP measured by subdural method [(15.03±5.80) mmHg; P>0.05]. The standard deviation of ICP measured by subdural method was (1.6±2.1) mmHg. ICP measured by subdural method was positively correlated with the gold standard (r=0.892, P<0.001). Postoperative intracranial infection occurred in 1 patient (1.78%) and light intracranial hemorrhage occurred in 1 (1.78%). Conclusions Hydraulic coupling device through subdural drainage tube can accurately monitor the ICP after craniotomy, which is more simple and economical, and easier to be promoted and applied in basic hospitals compared with ventricular ICP monitoring.

参考文献/References:

[1]中华医学会神经外科学分会，中国神经外科重症管理协作组. 中国神经外科重症管理专家共识（2020版）[J]. 中华医学杂志，2020，100（19）：1443-1458.
[2]李露寒，华　莎. 成人重型颅脑损伤的护理管理[J]. 中国临床神经外科杂志，2021，26（10）：807-809.
[3]Cremer OL, van Dijk GW, van Wensen E, et al. Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury [J]. Crit Care Med, 2005, 33(10): 2207-2213.
[4]Freeman WD. Management of intracranial pressure [J]. Continuum (Minneap Minn), 2015, 21(5 Neurocritical Care): 1299-1323.
[5]毛进鹏，陶治鹤，胡　伟，等. 重型颅脑损伤合并多发伤的救治[J]. 中国临床神经外科杂志，2018，23（5）：362-363.
[6]Treggiari MM, Schutz N, Yanez ND, et al. Role of intracranial pressure values and patterns in predicting outcome in traumatic brain injury: a systematic review [J]. Neurocrit Care, 2007, 6(2): 104-112.
[7]徐　晓，高利华，梁陶媛. 重型颅脑损伤术后感染相关因素及针对性护理的效果观察[J]. 中国临床神经外科杂志，2020，25（11）：791-793.
[8]Carney N, Totten AM, O'Reilly C, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition [J]. Neurosurgery, 2017, 80(1): 6-15.
[9]中国医师协会神经外科医师分会，中国神经创伤专家委员会. 中国颅脑创伤颅内压监测专家共识[J]. 中华神经外科杂志，2011，27（10）：1073-1074.
[10]Lin JP, Zhang SD, He FF, et al. The status of diagnosis and treatment to intracranial hypotension, including SIH [J]. J Headache Pain, 2017, 18(1): 4.
[11]石碑田，肖　波，周小舟，等. 持续有创颅内压监测在颅脑损伤术后的应用价值[J]. 安徽医学，2018，39：926-928.
[12]吴海航，叶少波，叶敏球，等. 简易颅内压监测仪的临床应用研究[J]. 临床和实验医学杂志，2013，12（5）：370-371.
[13]王　冕，沈李奎，周　强，等. 颅内压监测探头植入及侧脑室引流患者颅内感染的危险因素[J]. 中华医院感染学杂志，2022，32（17）：2624-2627.
[14]Adigun OO, Al-Dhahir MA. Anatomy, Head and Neck, Cerebrospinal Fluid [M]. Treasure Island (FL): StatPearls Publishing, 2022.
[15]李小丽，许红梅，王梅林. 体位干预对颅脑损伤病人颅内压的影响[J]. 护理研究，2014，28（12）：4373-4374.
[16]Lawley JS, Petersen LG, Howden EJ, et al. Effect of gravity and microgravity on intracranial pressure [J]. J Physiol, 2017, 595(6): 2115-2127.
[17]Berghmans M, de Ghellinck L, De Greef J, et al. Outcome of patients with surgical site infection after craniotomy [J]. Surg Infect (Larchmt), 2022, 23(4): 388-393.
[18]Hacker E, Ozpinar A, Fernandes D, et al. The utility of routine head CT for hemorrhage surveillance in post-craniotomy patients undergoing anticoagulation for venous thromboembolism [J]. J Clin Neurosci, 2021, 85: 78-83.

相似文献/References:

[1]张　祥　王增亮　汪永新　吴淦春　朱晓锋.标准大骨瓣减压术结合颅内压监测治疗大面积脑梗死的临床分析[J].中国临床神经外科杂志,2015,(08):497.[doi:10.13798/j.issn.1009-153X.2015.08.020]
[2]肖国民　李　俊.大脑中动脉动脉瘤急诊开颅手术体会[J].中国临床神经外科杂志,2015,(02):109.[doi:10.13798/j.issn.1009-153X.2015.02.016]
[3]孟志勇 库洪彬.进展型外伤性硬膜下积液治疗分析[J].中国临床神经外科杂志,2015,(02):128.[doi:10.13798/j.issn.1009-153X.2015.02.024]
[4]董建平　王和平　罗志伟　顾伟红　杨永华　张　晖　蔡　磊　叶权亿.开颅手术皮下引流管细菌学监测结果分析[J].中国临床神经外科杂志,2016,(08):497.[doi:10.13798/j.issn.1009-153X.2016.08.020]
[5]张洪微,窦榕榕,渠雪红,等.血清降钙素原在开颅术后颅内感染早期诊断中的价值[J].中国临床神经外科杂志,2016,(12):756.[doi:10.13798/j.issn.1009-153X.2016.12.008]
　ZHANG Hong-wei,DOU Rong-rong,QU Xue-hong,et al.The value of serum procalcitonin to early diagnosis of acute bacterial intracranial infection after craniotomy[J].,2016,(10):756.[doi:10.13798/j.issn.1009-153X.2016.12.008]
[6]吴　亮,宋子木,夏鹤春,等.垂体脓肿的临床特点及经鼻蝶显微手术治疗[J].中国临床神经外科杂志,2016,(12):771.[doi:10.13798/j.issn.1009-153X.2016.12.013]
[7]牛嗣强　李　刚　刘玉光.高血压性脑出血血肿引流术后颅内压监测[J].中国临床神经外科杂志,2017,(03):182.[doi:10.13798/j.issn.1009-153X.2017.03.020]
[8]周　健　陈谦学.清创联合抗生素持续封闭冲洗引流术治疗开颅术后硬膜外及硬膜下脓肿[J].中国临床神经外科杂志,2017,(05):318.[doi:10.13798/j.issn.1009-153X.2017.05.012]
　ZHOU Jian,CHEN Qian Xue..Application of debridement and continuous closed irrigation and drainage to the treatment of epidural and subdural abscess after craniotomy[J].,2017,(10):318.[doi:10.13798/j.issn.1009-153X.2017.05.012]
[9]张禄波　傅继东　遇旭东　丁建军　李　磊　王克辉.颅内压监测在重型颅脑损伤病人甘露醇应用中的意义[J].中国临床神经外科杂志,2017,(05):334.[doi:10.13798/j.issn.1009-153X.2017.05.018]
[10]高　涢　田春雷 综述　王雄伟 审校.创伤性胼周动脉动脉瘤的诊断与治疗[J].中国临床神经外科杂志,2017,(05):360.[doi:10.13798/j.issn.1009-153X.2017.05.029]

备注/Memo

备注/Memo:
（2022-08-21收稿，2022-09-12修回）
通讯作者：黄传平，E-mail：13503023691@163.com
更新日期/Last Update: 2022-11-30