Effect of Minimal Invasive Hematoma Aspiration on Intracranial Pressure in Patients with Supratentorial Intracerebral Hemorrhage

Abstract

Abstract:

Objective To observe the effect of minimal invasive hematoma aspiration on intracranial pressure in patients with supratentorial intracerebral hemorrhage and evaluating the efficacy of this treatment. Methods Patients who were underwent minimal invasive hematoma aspiration were recruited from Apr. 2013 to Dec. 2014. We observed the intracranial pressure (ICP) change before and after the surgery and early neurological outcomes of these subjects. Results Fifty-three patients were recruited. At the 14th day after the operation/discharge day, the GCS score was significantly higher than the baseline (7[5, 11] vs 12[9, 15], Z=-5.057, P<0.001), and the National Institutes of Health Stroke Scale (NIHSS) score was lower than the baseline (19[15, 23] vs 14[11, 18], Z=-4.210, P<0.001). The hematoma volume of the end of treatment was obviously less than the baseline (67.5[48.2, 82.2]ml vs 17.2[11.8, 25.8]ml, Z=-6.048, P<0.001). 29 subjects were underwent intracranial pressure monitor before the surgery. The postoperative ICP was significantly lower than the preoperative ICP (14[9.5, 21.5]mmHg vs 30[21.5, 40]mmHg, Z=-4.705, P<0.001). There was no correlation between first clot aspiration rate and ICP reduction rate (r=0.162, P=0.401). There was no difference of preoperative ICP, postoperative ICP, amount of ICP reduction and ICP reduction rate between good prognosis group and poor prognosis group. Conclusion Minimal invasive hematoma aspiration is effective in treating supratentorial intracerebral hemorrhage, which can improve early neurological outcomes, relieve mass effect of hematoma and decrease ICP. And there is no significant effect on early prognosis of preoperative ICP, postoperative ICP and the ICP change from this surgery.

Key words: Intracerebral hemorrhage; Minimal invasive hematoma aspiration; Intracranial pressure

摘要：

目的观察微创颅内血肿抽吸引流术对幕上脑出血患者颅内压的影响，从而进一步评估该治疗方法的疗效。方法选择2013年4月～2014年12月行微创颅内血肿抽吸引流术治疗幕上脑出血患者，观察患者手术前后颅内压变化及早期预后情况。结果共入组53例患者，术后14?d/出院Glasgow意识障碍量表（Glasgow Coma Scale，GCS）评分显著高于术前［7（12（9，15） vs 7（5,11），Z＝-5.057，P＜0.001］，美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分低于术前［14（11，18） vs 19（15，23），Z＝-4.210，P＜0.001］。终点血肿体积较基线减小［17.2（11.8，25.8）ml vs 67.5（48.2，82.2）ml，Z＝-6.048，P＜0.001］。其中29例患者行颅内压监测，结果显示术后颅内压较术前颅内压降低［14（9.5，21.5）mmHg vs 30（21.5，40）mmHg，Z＝-4.705，P＜0.001］，但颅内压降低率与首次血肿抽吸率之间无相关性（r＝0.162，P＝0.401）。行颅内压监测的患者早期预后良好组与不良组的术前颅内压、术后颅内压、颅内压降低量、颅内压降低率无显著差异。结论微创颅内血肿抽吸引流术治疗幕上脑出血有效，可改善早期神经功能预后，减轻血肿占位效应，并显著降低颅内压。术前后颅内压及术中颅内压变化对于脑出血早期预后的影响不明显。

关键词: 脑出血; 微创颅内血肿抽吸引流术; 颅内压

YANG Jun, YANG Bo, YANG Zhong-Hua, CHEN Sheng-Yun, ZHAO Xing-Quan. Effect of Minimal Invasive Hematoma Aspiration on Intracranial Pressure in Patients with Supratentorial Intracerebral Hemorrhage[J]. Chinese Journal of Stroke, 2015, 10(05): 401-406.

杨骏，杨波，杨中华，陈胜云，赵性泉. 微创颅内血肿抽吸引流术对幕上脑出血患者颅内压的影响[J]. 中国卒中杂志, 2015, 10(05): 401-406.

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