Clinical Significance Of Dynamic Monitoring By Transcranial Doppler Ultrasound And Intracranial Pressure Monitor After Surgery Of Supratentorial Hypertensive Intracerebral Hemorrhage

Objective:By the means of the monitoring of ICP and TCD to investigate the surgical method of supratentorial hypertensive intracerebral hemorrhage (HIH) and how to control the postoperative blood pressure. To explore whether PI can accurately reflect the changes in intracranial pressure.Methods:116 HIH patients were performed the craniotomic hematoma dissection (CHD) and the hematoma -cavity drilling drainage(HCDD), respectively, meanwhile, the intracranial pressure and mean arterial pressure of each patient were continuously monitored for 7days, the postoperative 1st,3rd,7th and 14th-day average flow velocities and pulsatility indexes of the bilateral middle cerebral arteries were monitored. Operation curative effect was evaluated by GOS(1 month after operation) and ADL(6 months after operation).Results:For hypertensive cerebral hemorrhage patients,the main factors influencing the prognosis of patients were blood pressure and GCS at admission、 location of hematoma、hematoma volume、operation time and operation method. By comparison CHD and HCCD, there is no significant difference in the short-term (GOS classification 1 month later) and long-term quality of life (ADL classification 6 months later) of patients with hematoma within 30-50ml. Meanwhile, there is no significant difference in the postoperative 1st,3rd,7th and 14th-day TCD parameter analysis betweenCHD and HCCD. But CHD exhibited the significant difference in the short-term (GOS classification 1 month later) and long-term quality of life (ADL classification(6 months later) of patients with hematoma more than 50 ml than HCDD; furthermore, the postoperative 1st,3rd,7th and 14th-day TCD parameter analysis revealed that CHD exhibited better results in relieving the intracranial pressure and improving the cerebral blood flow than HCDD, and the postoperative ICP and MAP monitoring towards all patients could effectively control the blood pressure to prevent the further bleeding and postoperative cerebral infarction. ICP is linear correlation with PI, when ICP is in the range of 5-60mmHg, they are approximately linear relationship. Establish regression equation to forecast TCP and CPP:ICPe=7.086+20.50PI+0.051MAP, CPPe=7.094-20.450PI+0.965MAP。Conclusions:1、Patients with hematoma within 30-50ml should preferentially choose HCDD.2、Patients with hematoma more than 50 ml should choose CHD.3、All HICH patients should be routinely performed the ICP and MAP monitoring after operation.4、To control MAP in the range of 95-105mmHg to achieve the purpose of controlling blood pressure to reduce the rate of postoperative rebleeding and prevent postoperative cerebral infarction.5、it shows that PI can accurately reflect the changes in intracranial pressure.