本文選題：顱內(nèi)壓　切入點(diǎn)：腦內(nèi)血腫　出處：《蘇州大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討顱內(nèi)壓監(jiān)測(cè)在自發(fā)性腦內(nèi)血腫患者治療中的應(yīng)用價(jià)值，通過(guò)對(duì)同側(cè)大腦半球及雙側(cè)腦室在有腦出血所致占位效應(yīng)的情況下，比較分析顱內(nèi)壓監(jiān)測(cè)數(shù)值變化情況，為自發(fā)性腦內(nèi)出血的顱內(nèi)壓監(jiān)測(cè)及臨床治療提供參考。 方法選擇2011年3月至2013年3月，長(zhǎng)寧區(qū)中心醫(yī)院神經(jīng)外科收治的自發(fā)性腦出血患者120例。將患者隨機(jī)分為監(jiān)測(cè)組和非監(jiān)測(cè)組。在監(jiān)測(cè)組內(nèi)又根據(jù)顱內(nèi)血腫的位置：以腦實(shí)質(zhì)為主分為監(jiān)測(cè)組1；以腦室出血為主分為監(jiān)測(cè)組2，分別進(jìn)行顱內(nèi)血腫穿刺術(shù)。比較分析監(jiān)測(cè)組和非監(jiān)測(cè)組患者術(shù)后3個(gè)月預(yù)后情況（GOS評(píng)價(jià)）、術(shù)后并發(fā)癥的發(fā)生情況、脫水劑使用量以及住院時(shí)間。同時(shí)比較監(jiān)測(cè)組患者不同位置顱內(nèi)壓的變化情況。 結(jié)果與非監(jiān)測(cè)組患者44.4%相比，監(jiān)測(cè)組患者預(yù)后良好比率明顯提高，可達(dá)78.33%，預(yù)后重殘及死亡比率明顯下降，均為5.00%。與非監(jiān)測(cè)組患者相比，監(jiān)測(cè)組患者甘露醇脫水劑的使用量明顯減少，平均住院時(shí)間明顯縮短。與非監(jiān)測(cè)組患者相比，監(jiān)測(cè)組患者術(shù)后電解質(zhì)紊亂及腎功能損害等并發(fā)癥的發(fā)生率均明顯下降，，分別為18.33%和1.67%，差異均具有統(tǒng)計(jì)學(xué)意義（P＜0.05）。通過(guò)對(duì)監(jiān)測(cè)組1及監(jiān)測(cè)組2術(shù)中的顱內(nèi)壓數(shù)值的觀察，硬膜下0cm硬膜下1cm硬膜下2cm硬膜下3cm硬膜下4cm硬膜下5cm，顱內(nèi)壓數(shù)值呈現(xiàn)逐步上升的趨勢(shì)，存在明顯的梯度變化。對(duì)監(jiān)測(cè)組2的顱內(nèi)壓數(shù)值的變化情況顯示，占位效應(yīng)處腦組織壓力非占位處腦組織的壓力。在甘露醇使用前后各30min，顱內(nèi)壓的情況均表現(xiàn)為：占位效應(yīng)處腦組織壓力非占位處腦組織壓力，且二者之間呈現(xiàn)一定的梯度變化。且隨著尿激酶注射量的增加（顱內(nèi)占位效應(yīng)的增加）雙側(cè)顱內(nèi)壓均呈現(xiàn)上升趨勢(shì)并存在明顯的梯度關(guān)系。隨著顱內(nèi)血腫的減少（顱內(nèi)占位效應(yīng)的減少），二者出現(xiàn)下降趨勢(shì)但仍存在一定的梯度變化，差異具有統(tǒng)計(jì)學(xué)意義（P＜0.05）。 結(jié)論顱內(nèi)壓監(jiān)測(cè)能夠指導(dǎo)臨床合理應(yīng)用降顱壓藥物，對(duì)降低藥物不良反應(yīng)的發(fā)生，改善患者的預(yù)后具有十分重要的意義。同時(shí)，自發(fā)性腦出血后顱腔不同部位的壓力是不相同的，存在一定的壓力梯度的變化，并且顱內(nèi)壓力梯度是從占位效應(yīng)處向外不斷減小。腦內(nèi)血腫患者行顱內(nèi)壓監(jiān)測(cè)時(shí)探頭應(yīng)盡可能放置在血腫內(nèi)或其附近，這樣更有助于臨床上判斷病情變化，為治療提供準(zhǔn)確的參考。
[Abstract]:Objective to explore the value of intracranial pressure monitoring in the treatment of patients with spontaneous intracerebral hematoma. To provide reference for intracranial pressure monitoring and clinical treatment of spontaneous intracerebral hemorrhage. Methods from March 2011 to March 2013, 120 cases of spontaneous intracerebral hemorrhage were randomly divided into monitoring group and non-monitoring group. According to the location of intracranial hematoma in the monitoring group, cerebral parenchyma was divided into monitoring group (1) and monitoring group (1) according to the location of intracranial hematoma. Intracerebroventricular hemorrhage was divided into monitoring group (2) and intracranial hematoma puncture respectively. The prognosis of the patients in the monitoring group and the non-monitoring group were compared and GOS was used to evaluate the postoperative complications. The amount of dehydrating agent and the length of stay were also compared between the monitoring group and the monitoring group. Results compared with the non-monitoring group (44.4%), the rate of good prognosis in the monitoring group was 78.33, and the ratio of severe disability and death was 5.000.Compared with that of the non-monitoring group, the prognosis of the patients in the monitoring group was significantly higher than that in the control group. The use of mannitol dehydrating agent in the monitoring group was significantly reduced, and the average hospitalization time was shortened. Compared with the non-monitoring group, the incidence of complications such as electrolyte disturbance and renal dysfunction in the monitoring group were significantly decreased. The difference was statistically significant (P < 0.05). The Intracranial pressure in Group 1 and Group 2 was observed. Subdural 0cm subdural 1cm subdural 2cm subdural 2cm subdural 4cm subdural 5 cm, intracranial pressure values showed a gradual upward trend, there was a significant gradient change. The pressure of brain tissue in the space occupying effect was not the pressure of the brain tissue in the space occupying place. 30 minutes before and after mannitol use, the intracranial pressure was: the pressure of the brain tissue in the space occupying effect, the pressure of the brain tissue in the non-occupying place, the pressure of the brain tissue in the non-occupying place. With the increase of urokinase injection (intracranial occupying effect), the bilateral intracranial pressure showed an upward trend and there was a significant gradient relationship with the decrease of intracranial hematoma. (the decrease of intracranial space occupying effect, both of them have a downward trend, but there is still a certain gradient change, The difference was statistically significant (P < 0.05). Conclusion Intracranial pressure monitoring can guide the rational use of intracranial pressure drugs in clinical practice, and it is of great significance to reduce the occurrence of adverse drug reactions and improve the prognosis of patients. After spontaneous intracerebral hemorrhage, the pressure in different parts of the cranial cavity is different, and there is a change of pressure gradient. The intracranial pressure gradient is decreasing from the space occupying effect to the outside. The probe should be placed in or near the intracranial hematoma in patients with intracerebral hematoma as much as possible, which is helpful to judge the change of the disease in clinic. To provide accurate reference for treatment.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.34

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 侯德朋;沈倩;郭興濤;;外傷性遲發(fā)性大腦半球間縱裂血腫的診治探討[J];青島大學(xué)醫(yī)學(xué)院學(xué)報(bào);2009年06期

2 羅澤彬;鐘東;唐文淵;廖正步;;腦實(shí)質(zhì)內(nèi)顱內(nèi)壓監(jiān)護(hù)在小骨窗開(kāi)顱治療幕上高血壓腦出血患者中的應(yīng)用[J];第三軍醫(yī)大學(xué)學(xué)報(bào);2011年12期

3 柯以銓,李鋼,張慶國(guó),雷洪伊;外傷性大腦縱裂血腫31例臨床分析[J];第一軍醫(yī)大學(xué)學(xué)報(bào);2004年03期

4 王凡;胡陽(yáng)春;徐源;楊明;彭崗;嚴(yán)雄;楊華;隋健美;劉健;;閃光視覺(jué)誘發(fā)電位無(wú)創(chuàng)顱內(nèi)壓監(jiān)測(cè)技術(shù)應(yīng)用于重型顱腦損傷的臨床觀察[J];第三軍醫(yī)大學(xué)學(xué)報(bào);2012年18期

5 李亞明;閆光輝;;顱內(nèi)血腫術(shù)后顱內(nèi)壓監(jiān)測(cè)的臨床應(yīng)用[J];中國(guó)實(shí)用神經(jīng)疾病雜志;2009年17期

6 陳平;;有創(chuàng)顱內(nèi)壓監(jiān)測(cè)并腦室外引流在重型顱腦損傷中的應(yīng)用[J];西南軍醫(yī);2012年02期

7 劉青蕊;王新存;崔鵬;米小昆;;腦出血患者早期血腫擴(kuò)大相關(guān)危險(xiǎn)因素的臨床分析[J];腦與神經(jīng)疾病雜志;2009年02期

8 朱盛;王東華;黃文強(qiáng);周亮;;顱內(nèi)壓監(jiān)護(hù)在急性顱腦損傷術(shù)后的臨床應(yīng)用[J];繼續(xù)醫(yī)學(xué)教育;2012年10期

9 陳國(guó)鋒;陳志斌;宋海鵬;;腦實(shí)質(zhì)內(nèi)顱內(nèi)壓監(jiān)護(hù)對(duì)小骨窗開(kāi)顱治療高血壓幕上腦出血的應(yīng)用研究[J];河北醫(yī)學(xué);2013年05期

10 徐兵;;青年人高血壓腦出血61例臨床分析[J];現(xiàn)代醫(yī)學(xué);2008年06期

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