The Significance Of Intracranial Pressure Monitoring In The Treatment Of Hypertensive Basal Ganglia Hemorrhage By Puncture Aspiration

Objective To investigate the characteristics of intracranial pressure(ICP)in patients with hypertensive basal ganglia hemorrhage And the significance of intracranial pressure monitoring in the treatment of hypertensive basal ganglia hemorrhage by puncture aspiration.Method A prospective study was performed on 50 patients with hypertensive basal ganglia who underwent puncture and aspiration during the neurosurgery of the Third Affiliated Hospital of Soochow University from 2017-01-01 to 2018-12-31.Recording demographic data,clinical features,imaging data,real-time dynamic changes in ICP,cerebral perfusion pressure(CPP)before and after hematoma aspiration,postoperative intracranial rebleeding rate and infection rate,tracheal stoma rate,30-day mortality after surgery,and GOS at discharge.To analyze the correlation between ICP initial pressure and hematoma volume,age and state of consciousness.The dynamic changes of postoperative ICP and CPP and their relationship with prognosis were recorded.Analyze the influencing factors of patient prognosis.Results 1 General data There were 50 patients in this study,including 35 males and 15 females;the age ranged from 26 to 80 years old,with an average of(57.76±14.74)years old;the hematoma volume was 20～103 ml,with an average of(52.74±20.79)ml;GCS5～14points,average(8.84±2.71)points,including 27 cases of severe cases(10 cases of cerebral palsy patients),23 cases of non-severe patients;ICP initial pressure 5～77mmHg,average(25.7±15.25)mmHg;After aspiration,the final pressure of ICP was 2～23mmHg,with an average of(7.98 ± 4.4)mmHg;the duration of intracranial hypertension was 25～289h,with an average of(102.37±50.81)h;intracranial rebleeding in 3 cases(6%);tracheostomy in 3 cases(6%);no cases of intracranial infection.Two patients were discharged automatically due to non-medical factors.Of the 48 patients,4(8.3%)died within 30 days after surgery,and 43 patients had a good prognosis(89.6%).2 ICP characteristics of basal ganglia hemorrhage 2.1 The intracranial pressure probe measured ICP at different positions in the brain.ICP under the cortex and the hematoma cavity were 17.96±16mmHg and 21.5±13.39mmHg,respectively.2.2 ICP initial pressure was positively correlated with hematoma volume(r=0.551,P=0.001);negatively correlated with age(r=-0.196,P=0.174).There was a negative correlation with age(r=-0.196,P=0.174),and a significant negative correlation with age when the hematoma volume was greater than 40 ml(r=-0.4,P=0.016).2.3 ICP initial pressure was negatively correlated with GCS(r=-0.469,P=0.001),and severely ill patients were significantly higher than non-severe patients(31.81 ± 17.41,18.52 ± 7.75,P=0.001)mmHg,patients with severe cerebral palsy were significantly higher than those with non-cerebral palsy(47.5±16.45,22.59±9.79,P=0.001)mmHg,young patients with severe disease were significantly higher than elderly patients(42.6±15.34,24.25± 12.18,P=0.019)mmHg.3;The effect of puncture surgery on ICP The initial and final ICP pressures were(25.7±15.25,7.98 ±4.4,P=0.001)mmHg,and the ICP amplitude was positively correlated with the initial pressure of ICP(r=0.445,P=0.001).The first ICP value of the patient’s NICU was 17.12 ±12.36mmHg,which was significantly higher than the ICP final pressure.The first ICP values of patients with mild,moderate and severe ICP were 14.45±9.15mmHg,17.09±6.92mmHg and 27±28.23mmHg,respectively.The initial ICP value of NICU was positively correlated with ICP initial pressure(r=0.503,P=0.001).The duration of intracranial hypertension was significantly longer in patients with severe disease than in non-severe patients(124.54±58.8,76.57 ± 24.57,P=0.001)h,and cerebral palsy patients were longer than non-cerebral palsy patients(151.29±73.66,113.53±49.94,P=0.157)h.Among the critically ill patients,young patients were older than elderly patients(148±85.72,120.73±28.61)h.4 ICP,CPP and prognosis The maximum mean ICP of 2 patients with cerebral palsy death was significantly greater than that of patients with severe and non-severe patients with good prognosis(93±22.63,33.05± 12.01,27.9±8.02,P<0.05)mmHg.The total time of severe intracranial hypertension in 2 patients with cerebral palsy death was significantly higher than that in the prognosis group(77.3±10.32,0.53±2.22,P=0.002)%.The minimum mean CPP of 2 patients with cerebral palsy death was significantly lower than that of patients with severe and non-severe patients with good prognosis(12±1.414,49.86±11.45,60.05±8.19,P<0.05)mmHg.The total time of CPP<50mmHg in 2 patients with cerebral palsy death was significantly higher than that in the prognosis group(35.75±36.42,0.25±0.94,P=0.002)%.The total time of CPP>90mmHg in 2 patients with cerebral palsy death was less than that in the prognosis group(10±14.14,20.4±15.77,P=0.368)%.The mortality rate was 75%when the initial pressure of ICP was≥50mmHg,and the mortality was 100%when the initial pressure of ICP was≥70mmHg.5 Factors affecting prognosis in patients undergoing puncture surgery The volume of hematoma in the poor prognosis and prognosis group was(85.4±18.37,48.83±17.85,P=0.001).The timing of surgery was(9.8±11.37,32.42±39.83,P=0.044)h.GOS was negatively correlated with hematoma volume,ICP initial pressure and ICP final pressure(r=-0.593,-0.429,-0.309,P<0.05).GOS was positively correlated with GCS and timing of surgery(r=0.268,0.276,P>0.05).Conclusion 1.ICP in patients with cerebral hemorrhage is determined by hematoma volume and compensatory capacity(age).ICP is positively correlated with hematomas and age is negatively correlated.ICP of severe patients was significantly higher than that of non-severe patients.ICP of patients with cerebral palsy was significantly higher than that of non-cerebral palsy patients.The ICP of young patients was significantly higher than that of elderly patients.Young patients with the same hematoma volume should be treated with aggressive surgery.2.There is a pressure gradient in the cranial cerebral hemorrhage.The farther away from the hematoma,the lower the pressure.The hematoma pressure represents the highest value of intracranial pressure.3.Partial hematoma aspiration can effectively reduce intracranial pressure in patients with cerebral hemorrhage and the ICP decline was more pronounced in critically ill patients and patients with severe cerebral palsy.4.There was a rebound in ICP after puncture,and patients with severe intracranial hypertension before surgery rebounded significantly.ICP is significantly higher than the general anesthesia state under real conditions,so good ventilation and sedation and analgesia are effective ways to reduce intracranial pressure.5.Patients with severe cerebral hemorrhage have a longer duration of postoperative cranial hypertension.ICP monitoring is helpful for the development of comprehensive intracranial pressure reduction measures.6.Postoperatively severe intracranial hypertension and hypoperfusion pressure indicate intracranial changes and poor prognosis.Effective blood perfusion can improve prognosis,but the significance of CPP upper limit in clinical practice needs further study.7.Puncture aspiration can effectively remove hematoma,reduce ICP,improve CPP,and does not increase the risk of rebleeding.It can be used as the first choice for the treatment of mild to moderate hypertensive cerebral hemorrhage:severe cerebral hemorrhage is not a contraindication to puncture and aspiration,but for patients with very severe intracranial hypertension(ICP initial pressure ≥ 60mmHg),craniotomy may be more beneficial.Because young patients with the same hematoma volume are more prone to cranial hypertension,younger patients need active surgery compared to older patients.8.The volume of intracranial hematoma is the decisive factor affecting the prognosis of patients,but the prognosis of patients is still affected by many factors such as their basic conditions,treatment methods and social factors.