| Objective:By studying the perioperative application of invasive intracranial pressure(ICP)in severe patients,the clinical application value of targeted treatment strategy of invasive intracranial pressure monitoring in perioperative severe patients can be explored further,so as to promote accurate and standardized treatment and improve the prognosis of patients.Methods:A total of 646 cases admitted to the Neurosurgery Diagnosis and Treatment Center of Shandong Qianfoshan Hospital were collected from January 2017 to December 2021,for retrospective cohort analysis.No invasive intracranial pressure monitoring was divided into ICP monitoring group and non-ICP monitoring group.The ICP monitoring group and non-ICP monitoring group were matched 1:1 with propensity score matching(PSM),and 286 patients were included in each study,totaling of 572 patients.Clinical data included patient gender,age,past medical history,time of onset from admission,glasgow coma score(GCS),time and total amount of mannitol application,postoperative complications,glasgow outcome score(GOS),hospital stay and cost,duration of treatment in the neurosurgical intensive care unit(NSICU).The monitoring device is the US Codman intracranial pressure monitor,and the probe is placed in intraventricular or parenchymal areas.The differences in the time and total amount of mannitol use,the incidence of postoperative intracranial infection and unplanned reoperation,hospital stay and cost between the two groups were compared and analyzed,and observe the mortality and prognosis of the two groups were observed.Results:1.After matching,there was no statistical difference in sex ratio,age,previous smoking,alcohol consumption,previous hypertension,diabetes,GCS score at admission,and time from admission between the two groups(P>0.05).2.The number of days with mannitol in the ICP monitoring group was 5.00(2.00,9.00)days,lower than that in the non-ICP monitoring group 10.00(4.00,15.00)days,which was statistically significant(P<0.01).The total amount of mannitol in the ICP monitoring group was 1875.00(750.50,2837.50)ml,while the number in the ICP monitoring group was 2312.50(600.00,450,000.00)ml.The total amount of mannitol in the ICP monitoring group was lower than that in the non-ICP monitoring group(P<0.01).3.25 patients had intracranial infection,and the infection rate was 8.74%,while the non-ICP surveillance group had 30 cases and intracranial infection accounted for 10.49%.The difference was not statistically significant(P=0.570).In terms of the rate of unplanned reoperation,there was also no statistical difference between the ICP monitoring group 15(5.24%)and the non-ICP monitoring group 27(9.44%)(P=0.078).4.There was no statistically significant difference between the lengths of hospital stay in the ICP monitoring group was 16.00(8.00,25.00)days in the non-ICP monitoring group(P=0.329).However,for the NSICU,4.50(5.00,14.00)days in the ICP monitoring group was lower than 10.00(5.00,14.00)days in the non-ICP monitoring group,which was statistically significant(P<0.01).The hospitalization cost of patients in the ICP monitoring group was 106 400(67300,154 400)yuan,which was significantly higher than that 53 600(31 100,89 800)yuan of patients in the non-ICP monitoring group.In terms of the cost of imaging examination,the ICP monitoring group was 3 800(2 300,5 600)yuan in the group and 35 00(2 400,5 400)yuan in the non-ICP monitoring group.There was no significant difference between the two groups(P=0.524).5.The in-hospital mortality of ICP group and non-ICP group were 14.3%and 10.5%,with no statistical difference between the two groups(P=0.163).According to the GOS score,81 patients in the ICP monitoring group had good prognosis,accounting for 28.3%,and 63 patients in the non-ICP monitoring group had good prognosis,accounting for 22%.The difference between the two groups was statistically significant(P=0.037).Conclusions:1.The targeted control therapy strategies with invasive intracranial pressure monitoring can reduce the duration and total amount of mannitol use in patients with critical neurological conditions.2.The use of invasive intracranial pressure monitoring is safe and does not increase the rates of intracranial infection and re-craniotomy.3.The use of invasive intracranial pressure monitoring does not reduce the total length of hospital stay,but it can reduce the time spent in the neurosurgical intensive care unit.4.The perioperative application of invasive intracranial pressure monitoring targeted control scheme for patients with acute and critical neurological severity can improve the prognosis of patients,which is worthy of further promotion. |
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