Intracranial Pressure In Patients With Monitoring Neurological Intensive Applications4Cases

Objective: to analysis of clinical effect of intracranial pressure monitoring in patientswith severe nerveMethods:we collection summary of the clinical data of the four cases in our hospitalfrom September2011to February2012use of intracranial pressure monitoring in patientswith neurological intensive, including3males and1female, age35-74years, mean61.5years. Hypertensive intracerebral hemorrhage1case，severe traumatic brain injury1case,2cases of ruptured intracranial aneurysm. One case of GCS score of12-14(mild coma),9-11(moderate coma) in three cases. In4cases,1patient with severe traumatic brain injury usesubdural intracranial pressure monitoring, conservative treatment;1case of hypertensiveintracerebral hemorrhage use intraventricular intracranial pressure monitoring andventricular drainage, and acute phase of patients with ruptured intracranial aneurysm useintraventricular intracranial pressure monitoring and ventricular drainage, after12days wesurgery intracranial aneurysm.1case of acute aneurysms underwent coiling, then useintracranial pressure monitoring and ventricular drainage. We applicated of the U.SJohnson’s Codman Intracranial Pressure Monitor to record the patient’s intracranial pressureand then recorded the patient’s GCS score, mean arterial pressure during hospitalization,treatment, and complications. According to monitoring results to reduce intracranial pressure,to maintain effective intracranial perfusion pressure, and combined with the clinicalsymptoms and imaging changes to decide whether surgical intervention. Follow-up threemonths after the treatment, we applicated Barther Index classification of patients toassessment activities of daily living (ADL), evaluation standard is divided into five levels: Ilevel of100points, patients can completely take care of themselves, fully restored social life;II level60~99points, their lives can basic take care of themselves, the partial restoration ofsocial life or family life can be carried out independently; III level for40to59, living needhelp but with others support walking; IV level of20to39，living is significantly dependenton others, on the bed but conscious; Ⅴgrade of20points or less, life is totally dependent onothers or the vegetative state..Results:4patients were increased intracranial pressure, one cases of slightly elevated, three cases of severe increased, the increased severe in two cases by increasing thedehydration of the dose or adjust ventricular drainage height gradually to below15mmHg,and then stop the dehydration treatment. Patients with intracranial pressure increased reviewof head CT showed obvious cerebral edema, midline shift, craniotomy to remove thehematoma and decompressive craniectomy surgery. Two cases of hydrocephalus patientsbefore and after removal of the ventricular drainage tube CT scan showed hydrocephalusapparent ease, three months after mild hydrocephalus asymptomatic continue to observe.One cases of subdural intracranial pressure monitoring, three cases of intraventricularcatheter guardianship placement days3-8days, intracranial pressure <15mmHg andsustained24hours after extubation. Barther index classification: Ⅰgrade1cases,2cases ofgrade Ⅲ, Ⅴ grade1cases.Four cases the placement of intracranial pressure probes were nointracranial infection.Conclusions: By four cases of patient monitoring process and results, and literature canbe drawn the following conclusions:1, intracranial pressure monitoring does not only applyto the of GCS <8patients with neurological intensive, for those GCS912points there isdeterioration in patients with a tendency toalso monitored indications.2, dehydrated drugdose adjustment based on intracranial pressure monitoring values and more reliable, toavoid dehydration excessive use of drugs.3, the intracranial pressure continued to>40mmHg would seriously endanger the life line conservative therapy need to activelydecompressive craniectomy in patients with intracranial pressure greater than60mmHg,whether or not surgery, the mortality rate is almost100%.4, nerves in patients with severeintracranial pressure monitoring clear surgical indications, delayed hematoma can be foundbefore the onset of clinical symptoms, and to keep abreast of brain edema, have a bettersense for the assessment of prognosis.