Comparative Study Of The Clinical Treatment Of Spontaneous Intracranial Hemorrhage (SICH) By Means Of Intracranial Pressure (ICP) Monitoring

【Objective】:This purpose of the study was to explore the value ofimplementing intracranial pressure monitoring in the treatment of spontaneousintracranial hemorrhage (SICH). A more detailed reference for clinical treatment ofSICH was provided by comparing the variation of intracranial pressure under thecondition that the mass effect occurred either in one hemisphere or in bothhemispheres.【Approaches】:120patients suffering from SICH who have been treatedin the department of neurosurgery in Changning Center Hospital from March2011to March2013were selected as the subjects of this study. Subjects were dividedinto2large groups: Monitored Group and Non-monitored Group. Monitored groupconsisted2subgroups: Monitored Group1(Parenchymal hemorrhage, while onehemisphere was monitored) and Monitored group2(Intraventricular Hemorrhage,while both hemispheres were monitored). Intracranial hematoma puncturesurgeries were performed for all groups. Surgery prognosis of three months withGlasgow Outcome Scale (GOS), the incidence of postoperative complications, thedosage of dehydrating agent and hospital stays of two groups were compared andanalyzed. The variation of intracranial pressure in different positions intracerebralbetween these2monitored groups was also compared.【Results】: Compared with the Non-monitored Group, the ratio of goodprognosis of the Monitored Group was much higher（78.33%versus44.4%）, theratio of severe disability and death is significantly lower； the dosage ofdehydrating agent was reduced greatly, so did the duration of hospital stays; the incidence of complications (e.g. renal dysfunction) and electrolyte imbalance aftersurgery were decreased as well.Based on the observation of data of Monitored Group1and Monitored Group2, the intracranial pressure (ICP) depicted a gradient increasing pattern as theintracranial pins detected deeper, i.e. data of0cm subdural＜data of1cm subdural＜data of2cm subdural＜data of3cm subdural＜data of4cm subdural＜data of5cm subdural. Data of Monitored Group2shows that the ICP of the brain tissueswith mass effect was higher than the ICP of the brain tissues without mass effect,with a gradient transition in between. The rule did not break after the dosing ofmannitol for30min. With the increase of injected dosage of urokinase (increasingmass effect), ICP of both hemispheres kept increasing, and still maintained agradient transition. With the reduction of intracranial hematoma (decreasing masseffect), ICP of both hemispheres decreased respectively, still maintaining agradient transition in between. All results in this study were proved to bestatistically significant (P＜0.05).【Conclusion】: ICP monitoring could work as guidance of meditationprescription, reduce the incidence of adverse drug effects and improve theprognosis of patients. Meanwhile, the ICP in different intracranial positions wereproved to be different, with a gradient transition from the most outside subdural tothe most inside subdural. Similar gradient transition was found between the braintissues with mass effect and the brain tissues without mass effect. The probes forSICH monitoring should be placed nearby the hematomas so as to offer precisereference for clinical diagnosis of patients.