The Application Of Invasive Intracranial Pressure Monitoring In Severe Craniocerebral Trauma And Severe Hypertensive Cerebral Hemorrhage

Objective: To investigate the guiding role of invasive intracranial pressure monitoring in severe craniocerebral injury and severe hypertensive cerebral hemorrhage on the removal and retention of bone flapwhen the intraoperative intracranial pressure value is20-25 mmhg,as well as the role of invasive intracranial pressure monitoring in the prevention of intraoperative complications.Methods:147 patients with severe craniocerebral trauma and severe hypertensive intracerebral hemorrhage admitted to the neurosurgery department of our hospital from September 2016 to September 2018(meeting the research criteria)were collected for retrospective analysis,and divided into experimental group and control group according to whether invasive intracranial pressure monitoring was applied.A total of 65 cases were collected in the experimental group,including 40 cases of severe craniocerebral trauma,33 cases of ventricular intracranial pressure monitoring probes,and 7 cases of subdural and parenchymal intracranial pressure monitoring probes.There were 25 cases of intracranial hematoma removal and bone flap removal under microscope,and 15 cases of intracranial hematoma removal and bone flap restoration under microscope.There were 25 cases of hypertensive cerebral hemorrhage,17 cases of ventricular intracranial pressure monitoring probes and 8 cases of subdural and parenchymal intracranial pressure monitoring probes.There were 12 cases of intracranial hematoma removal and bone flap removal under microscope,13 cases of intracranial hematoma removal and bone flap restoration under microscope.In the control group,44 patients with severe craniocerebral injury and 38 patients with hypertensive intracerebral hemorrhage were treated with microscopically intracranial hematoma removal and bone flap removal,microscopically intracranial hematoma removal and bone flap restoration,respectively,in 23 cases,21 cases,21 cases and 17 cases.By observing the incidence of postoperative complications of patients in the invasive intracranial pressure monitoring group and using GOS score to evaluate the prognosis,the differences between the two surgical methods were compared.Meanwhile,the changes of intraoperative intracranial pressure and postoperative intracranial pressure in the experimental group were integrated,and a relatively objective and practical intracranial pressure range was established as a reference for future surgical methods.Meanwhile,the incidence of intraoperative complications in the experimental group with invasive intracranial pressure and the control group without intracranial pressure monitoring was observed,and the effect of intraoperative monitoring of invasive intracranial pressure on the prevention of relevant complications was analyzed.Results: Surgery 1,invasive intracranial pressure monitoring group,the line operation 1(intracranial hematoma removal and bone flap removal under microscope)of 37 cases of patients,postoperative prognosis is good rate was 73.0%,the line operation 2(intracranial hematoma removal and bone flap restoration under microscope)of 28 cases of patients,postoperative prognosis is good rate was 71.4%,the overall prognosis of postoperative mortality in patients with invasive intracranial pressure monitoring group good rate was 72.3%.In the experimental group,the intraoperative intracranial pressure fluctuated between 20-25 mmhg in 42 patients with medium and severe craniocerebral trauma and hypertensive intracerebral hemorrhage,among which 23 patients received operation 1 and 19 patients received operation 2.Postoperative line GOS score(Ⅳ level above),respectively,for a good prognosis for 18 cases(78.3%),16 cases(84.2%),four row count data tablec2calibration test,under the inspection level a = 0.05,c2= 0.009,P﹥0.05,statistically is no difference.Surgery 2,in the experimental group with invasive intracranial pressure monitoring and the control group without intracranial pressure monitoring,there were 25 cases,12 cases,23 cases and 21 cases of operation 1,and there were 15 cases,13 cases,21 cases and 17 cases of operation 2,in severe craniocerebral trauma and severe hypertensive cerebral hemorrhage.In the experimental group,the favorable rate of operation 1 without intraoperative complications was 78.4%,that of operation 2 without intraoperative complications was 78.6%,and in the experimental group of invasive intracranial pressure monitoring,the overall good rate of no intraoperative complications was 78.5%.In the control group,the favorable rate of no complications in operation 1 was 52.3%;the favorable rate of no complications in operation 2 was 55.3%;in the control group without intracranial pressure monitoring,the overall favorable rate of no complications was53.7%.The intraoperative favorable rate was directly standardized for the invasive intracranial pressure monitoring group and the control group without intracranial pressure monitoring.The standardized intraoperative favorable rate for the invasive intracranial pressure monitoring group was 69.4%,and the standardized intraoperative favorable rate for the control group without intracranial pressure monitoring was60.0%,four row count data tablec2test,under the inspection level a = 0.05,c2 = 9.76,P<0.05,statistically is difference.Conclusions: First,when the intraoperative intracranial pressure fluctuates between20-25 mmhg in patients with severe intracranial trauma and severe hypertensive intracerebral hemorrhage in the experimental group by monitoring invasive intracranial pressure,there is no significant difference in the prognosis of GOS between the two surgical methods.The operative strategy can be selected according to the actual situation of patients during the operation.Second,through to the invasive intracranial pressure monitoring group and intracranial pressure monitoring in severe head trauma and severe hypertensive cerebral hemorrhage in the control group of intraoperative complications related to the emergence of the situation,found that under the guidance of intraoperative invasive intracranial pressure to bone disc decompression and bone flap Hai Na perioperative risk of intraoperative complications occurred is far less than no intracranial pressure monitoring,it can effectively prevent the generation of intraoperative adverse symptoms.