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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 mm Hg(1 mm Hg=0.133k Pa);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 mm Hg;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。
Objective To explore the value of intracranial pressure monitoring in the treatment of ruptured intracranial aneurysm. Methods Fifty-seven patients with ruptured aneurysm were implanted with basic or ventricular catheter-type intracranial pressure monitoring probe under craniotomy occlusion. Postoperative medication and cerebrospinal fluid drainage were monitored according to intracranial pressure monitoring. The patient prognosis and complications were analyzed. Results The postoperative intracranial pressure was lower than 20 mm Hg (1 mm Hg = 0.133 kPa) in 42 patients. In 13 patients, dehydration of mannitol was given according to the result of intracranial pressure monitoring, and the intracranial pressure was increased after cerebrospinal fluid drainage was less than 20 mm Hg ; 1 case of intracerebral hematoma patients improved after secondary surgery; 1 case of large area infarction patients died. Postoperative follow-up 3 to 6 months, CT examination found that 11 cases (19.3%) of patients with varying degrees of hydrocephalus, placement of intraventricular catheter-type intracranial pressure probe in patients with hydrocephalus incidence was 15.22%, significantly lower than the basic placement Type intracranial pressure probe 36.36% (P <0.05). Conclusion Intracranial pressure monitoring, especially intracranial ventricular catheterization, can observe the changes of postoperative aneurysm rupture aneurysm, guide the treatment and reduce the incidence of complications.