CAJ | 학술논문

目的探讨无创颅内压(NICP)监测在高血压脑出血(HICH)后血肿扩大早期预警中的作用及意义.方法应用NICP监测技术前瞻性地对158例HICH病例进行动态监护,经颅脑CT证实后分为血肿扩大(HE)组和血肿稳定(HS)组,并对两组NICP、脑灌注压(CPP)、血肿侧与健侧NICP的差值(D值)及预后进行对比分析.结果全组符合血肿扩大诊断59例(37.3％),其中91.5％的病例发生于起病12 h以内；同时,HE组NICP及D值较入院首测均显著增高(P=0.001和0.000),而CPP以及HS组NICP、CPP及D值则均与入院首测无显著改变(P＞0.05)；对D值≥1.3 mm Hg的病例数分析,入院首测时两组间差异无统计学意义(P=0.873),而血肿扩大或24h后复测HE组为51例(86.4％),较HS组的7例显著增多(P=0.000)；GOS评分HE组的良好率显著低于HS组(P=0.000),而植物生存及病死率则显著增高(P=0.005和0.036),但两组中残及重残的发生率差异均无统计学意义(P =0.604和0.256).结论 NICP因其无创、可连续监测的优点可能成为早期预警HICH后血肿再扩大的有效监测手段；而以D值作为观察指标时,这种预警可更为早期和敏感.
목적 탐토무창로내압(NICP)감측재고혈압뇌출혈(HICH)후혈종확대조기예경중적작용급의의.방법 응용NICP감측기술전첨성지대158례HICH병례진행동태감호,경로뇌CT증실후분위혈종확대(HE)조화혈종은정(HS)조,병대량조NICP、뇌관주압(CPP)、혈종측여건측NICP적차치(D치)급예후진행대비분석.결과 전조부합혈종확대진단59례(37.3％),기중91.5％적병례발생우기병12 h이내；동시,HE조NICP급D치교입원수측균현저증고(P=0.001화0.000),이CPP이급HS조NICP、CPP급D치칙균여입원수측무현저개변(P＞0.05)；대D치≥1.3 mm Hg적병례수분석,입원수측시량조간차이무통계학의의(P=0.873),이혈종확대혹24h후복측HE조위51례(86.4％),교HS조적7례현저증다(P=0.000)；GOS평분HE조적량호솔현저저우HS조(P=0.000),이식물생존급병사솔칙현저증고(P=0.005화0.036),단량조중잔급중잔적발생솔차이균무통계학의의(P =0.604화0.256).결론 NICP인기무창、가련속감측적우점가능성위조기예경HICH후혈종재확대적유효감측수단；이이D치작위관찰지표시,저충예경가경위조기화민감.
Objective To evaluate the clinical significance of noninvasive intracranial pressure (NICP) monitoring of early-warning hematoma enlargement in patients with hypertension intracerebral hemorrhage (HICH).Methods 158 cases with HICH Continuous monitoring NICP were divided into two groups comfirmedbased on brain CTs,the hematoma expanded (HE)group and the hematoma stable (HS) group.An analysis and comparison between the two groups were performed focusing on characteristics,such as the difference of NICPs between the hematoma side and the healthy side (D value),NICPs,cerebral perfusion pressures (CPP),and the Glasgow prognosis scores (GOS).were analyzed and compared between the two groups.Results 59 patients in 158 cases had sustained hematoma increased (accounting for 37.3％),of which 91.5％ occurred within 12 h.NICP and D values in the HE group significantly increased from first detection,while there were no significant changes of CPP in the hE group.NICP,CPP,and D values in the HS group were similar to the first test (P ＞ 0.05).According to the cases counted on the D value ≥ 1.3 mmHg,there were no significant differences between the two groups at the first measuring (P =0.873).However,51cases (86.4％) were met with the condition in the HE group after undone test,which is significantly higher than the HS group (P =0.000).The comparison of HE and HS groups'Glasgow prognosis score (GOS) showed that the good rate was significantly below (P =0.000),plant survival and mortality rates were significantly higher (P =0.005 and 0.036),and there were no significant differences in mild disability and severe disability rates (P =0.604 and 0.256).Conclusion NICP,characterized with non-invasive,simple operation,and continuous monitoring,may become an effective means of monitoring and detecting early warning hematoma enlargements in patients with HICH.When the D value is regarded as observed indicators,this warning may come earlier and be more sensitive.