Multivariate Analysis Of Intracranial Pressure Changes During Perioperative Period For Ruptured Intracranial Aneurysm

Objective:By analyzing the factors influencing the change of intracranial pressure and monitoring the change trend of intracranial pressure during perioperative period,we can judge the influence degree of the related factors on the change of intracranial pressure,which is of positive significance to the operation and related treatment.Methods:In this study,40 a SAH patients who underwent craniotomy and clipping were selected and divided into satisfied group and dissatisfied group according to the changes of intracranial pressure.For patients undergoing aneurysm craniotomy,intracranial pressure monitoring device was inserted before surgery to observe the changes of intracranial pressure,and the changes of intracranial pressure were determined by the value of intracranial pressure changes to determine whether the intraoperative intracranial pressure changes were satisfactory.Preoperative age,gender,history of hypertension,onset time,Hunt-Hess grading,Fisher grading,aneurysm location,mean CT score and other related factors were collected.SPSS25.0 software was used to analyze the collected data.Single-factor analysis and multi-factor Logistic regression analysis tests were designed to analyze the related factors affecting the changes of intracranial pressure during perioperative period.Results:1.Among the 40 patients meeting the inclusion and exclusion criteria,there were 21 males(52.5%)and 19 females(47.5%),with an average age of(60±10);25 patients had history of hypertension,15 patients denied history of hypertension;The time from onset to operation was 2h-36 h,with an average onset time of 12 h.Responsible aneurysms were located in anterior communicating artery in 16 cases,middle cerebral artery in 11 cases,posterior communicating artery in 11 cases,and posterior circulatory system in 2 cases.There were 9 hunt-Hess grade ⅱ,17 Hunt-Hess grade ⅲ,14 Hunt-Hess grade ⅳ.Fisher’s grading included 2 cases of ⅰ,16 cases of ⅱ,14 cases of ⅲ and 8 cases of ⅳ.2.x~2 test was used for single factor analysis of counting data,and T test was used for single factor analysis of measurement data.Gender(P=0.567),age(P=0.087),time from onset to operation(P=0.093),location of responsible aneurysm(P=0.889),and Hunt-Hess grading(P=0.121)had no statistical significance.The history of hypertension(P=0.014),Fisher’s grade(P=0.045)and mean CT value score(P=0.026)were statistically significant.3.Multivariate Logistic regression analysis was conducted on the factors that were significant after univariate analysis,indicating that: History of hypertension(P=0.02,OR=10.802,95%CI 1.449-80.557)and mean CT value score(P=0.028,OR=1.097,95%CI 0.957-1.257)were risk factors for changes in intracranial pressure.Conclusion:1.History of hypertension and mean CT score were independent risk factors for changes in intracranial pressure.The higher the history of hypertension and the mean CT score,the more unsatisfactory the change of intracranial pressure,increasing the difficulty and risk of surgery.2.2.By evaluating the preoperative head CT of patients,it is feasible to obtain the average CT value score through the method of this study,and to judge whether the changes of intracranial pressure are satisfactory and provide guidance for surgical operations.The lower the mean CT score,the more satisfactory the changes of intracranial pressure,and the higher the safety and reliability of surgery.