| Background and purposeAcute intracranial hematoma is the common emergency of neurosurgery which can be caused by trauma,hypertension or vessel malformation.The main pathophisical change is increasing of intracranial pressure(ICP),decreasing of cerebral perfusion pressure,hypoxia of brain tissue,even inducing of cerebral hernia,we used to choose operative indication due to patients' volume of hematoma,depth of coma,GCS scale,change of pupil,degree of deviation of midline,et al,but not a dynamic index.We also need an objective index which can show us whether there is delayed intracranial hematoma,how severe the cerebral edema has been,how to regulate the dosage of dehydrant.Today more and more scholars are inclining to regard ICP as the golden standard for operative indication.In the past papers about treatment of traumatic intracranial hematoma under the ICP monitoring were much more than those about intracranial hematoma induced by hypertension and they were usually studied separately.But this time,we studied traumatic intracranial hematoma and hypertensive intracranial hematoma together,to inquire the value of ICP monitoring in hematoma operative indication,delayed intracranial hematoma,cerebral edema and complications of acute intracranial hematoma.Method1.Including and excluding standard:(1)Inchuding standard a.all the cases are verified with intracranial hematoma by CT-scanning when admitted to hospital.We also had CT-Scanning to the cases at the third,the seventh day if the symytoms were stable,and had CT-Scannig at anytime when the symptoms changed.The ICP monitoring probes were also inserted at the first day.b.the cases can be divided into 2 groups as traumatic hematoma and hypertensive hematoma due to etiology, also can be divided into 4 groups as simple epidural hematoma,subdural hematoma complicated with intracerebral hematoma,mixed hematoma (epidural,subdural and intracerebral hematoma all exist)and simple intracerebral hematoma due to their location.(2)excluding standard:a.no hematoma found when admitted to hospital,b.chronic subdural hematoma or subacute subdural hematoma,c.intracerebral hematoma may be induced by A-V malformation or aneurgsm,d.spontaneous subarachnoid Hemorrhage.2.Assemble the data55 cases of intracranial hematoma were treated as monitoring team under the ICP monitoring from Oct 2004 to Oct.2006.The data include name,sex,age,address,phonenumber,clinic symptoms CT image,GCS scale,average ICP data,operative manner and diagnosis.We also studied 55 cases with intracranial hematoma as contrast team from Oct.2002 to Oct. 2004,which treated without ICP monitoring.The two groups have no significant difference in age,GCS scale,sex and constructive ratio of hematoma.3.ProcessingAll cases of monitoring team were treated under the ICP monitoring, all used intracerebral ICP monitoring probes.Different management was choosen due to the ICP data.If average ICP was between 15～20 mmHg, (low level increased),low dose of mannitol(125ml,per 12 hours)with glycerin fructose(250ml,per 12 hours)or albumin(10g,per 12 hours) were used.a lternately,and the trend of ICP should be cared of;If average ICP was between 20～40 mmHg(moderate level increased),operation or non-operation treatment was choosen due to the volume of hematoma,the changing trend of hematoma,The degree of deviation of midline and the trend of ICP;125mi or 150ml mannitol was used per 6 hours when non-operation treatment was choosen..If ICP was between 40～60 mmHg (high level increased),nearly all cases needed operation,but the outcome was not good whether operation or not,and the possibility of encephalocele was high;If ICP was more than 60 mmHg,non-operation treatment was adopted.If average ICP was less than 15 mmHg,dehydrant was not needed.If average ICP was less than 5 mmHg,infusion volume should be increased,in order to promote the brain swelling.In contrast team, treatment was choosen,due to volume of hematoma,GCS scale,size change of pupil,depth of coma..Other treatment was similar.Results1.Result of ICP monitoring:All cases in monitorig team had increased ICP at first.9 cases of low level,37 cases of moderate level,and 9 cases of high level;7 cases had low level ICP at first,which increased to moderate level later,and CT scanning showed 5 cases had enlarged hematoma or delayed hematoma,2 cases had severe brain edema with obviously deviation of midline,and all received operation.6 cases of high level ICP received operation.Other 3 cases of high level ICP were treated without operation because of too high level ICP(＞60 mmHg),expanding of both pupils and unstable vital signs.3 cases' ICP of low level decreased to less than 10 mmHg after 5～6 days,then dehydrant was cancelled,The persist time of ICP increased:24h～72h in 9 cases,＞72h in 46 cases.2.effect of therapy:we used GOS standard to evaluate effect of therapy after 3 months.In monitoring team,27 cases got good recovery (49.3%),15 cases got moderate disability(27.3%),6.cases got severe disability(10.9%),2 cases got vegetative status(3.63%)and mortality was 3 (9.1%);In contrast team,12 cases got good recovery(21.8%),11 cases got moderate disability(20%),15 cases got severe disability(27.3%),8 cases got vegetative status(14.5%),and mortality was 9(16.4%),the two groups had significant difference;(x~2=17.5 p＜0.05)3.Complications comparation:In monitoring team,10 cases suffered from electrolytes disbalance(18.2%),4 cases suffered from renal dysfunction(7.27%),2 cases suffered form delayed cerebral hernia,(3.63%); In coutrast team,18 cases suffered from electrolytes disbalance(32.8%),7 cases suffered from renal dysfuntion(12.7%),6 cases suffered from delayed cerebral hernia(10.9%).The two groups had difference,but difference was not significant in statistics.ConclusionPersist ICP Monitoring plays an aggressive role in mastering operative indication of intracranial hematoma,finding out delayed intracranial hematoma and brain swelling early,regulating the dosage of dehydrant, preventing renal dysfuntion and electrolytes disbalance.
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