Invasive Intracranial Pressure (ICP) Monitoring In Patients With Aneurysmal Subarachnoid Hemorrhage (aSAH) Merging Hydrocephalus

Objective:By review of aneurysmal subarachnoid hemorrhage with acute hydrocephalus in patients with intracranial pressure monitoring data,analysising the change trend of invasive intracranial pressure monitoring data,exploring related consequences,and providing invasive intracranial pressure monitoring references for clinical work.Methods:1 To retrospectively analyze the clinical data of 31 patients with aneurysmal subarachnoid hemorrhage(a SAH)with acute hydrocephalus,from September 2014 to August 2015,in the department of neurosurgery of He Bei general hospital.Inclusion criteria:(1)age 40 to 60 years old;(2)admitted to hospital 24 hours of adept skull CT examination for acute hydrocephalus,Glasgow coma scale(Glasgow coma score,GCS)3-12 points.(3)head CT of subarachnoid hemorrhage,whole cerebral angiography(DSA)check clear for ruptured intracranial aneurysm bleeding.(4)line of unilateral or bilateral intraventricular External drainage(External ventricular drainage,EVD),postoperative patients with intracranial pressure monitoring.Exclusion criteria:(1)head CT of subarachnoid hemorrhage,but there is no hydrocephalus and obvious nerve dysfunction,Glasgow coma scale on admission(Glasgow coma score,GCS)patients with 13 to 15 points,patients without ventricle puncture drainage.(2)the head CT combined subarachnoid hemorrhage of intracranial hematoma,midline structure shift is greater than 1cm,obvious nerve dysfunction,requires evacuation of hematoma and decompressive craniectomy.(3)whole cerebral angiography examination,identified as the non-aneurysm rupture hemorrhage patients(4)external the ventricle drainageline no postoperative intracranial pressure monitoring in patients with postoperative.(5)within 5 days adept lumbar puncture cerebrospinal fluid release,or lumbar cistrna drainage hemorrhagic cerebrospinal fluid.(6)death or automatic discharge in a critical condition.2 Postoperative patients returned to the wards to zero for the first time,postoperative intraventricular external drainage intracranial monitoring micro sensing device fixed to the foramen of monro or tragus zero level,and set the ICP upper limit is 25 mm Hg,lower limit of 5 mm Hg;Postoperatively in patients with high head of a bed about 30 °,strengthen turn back and sputum suction necessary: tracheotomy,postoperatively 25% mannitol 200 ml q12 h i.v.t.,continue to offer the hemostatic thetapy,reducing blood pressure,prevent seizures,calm,rehydration,such as conventional treatment,will all the research object of systolic blood pressure control in below 160 mm Hg,diastolic blood pressure control in below 100 mm Hg,but failed to reach shock,blood pressure,control of cerebral perfusion pressure(Cerebral perfusion pressure,CPP)in 60-70 mm Hg.Regular review of skull CT,monitoring of patients with GCS score.3 Record the change of the GCS score for 24 hours after admission,and on the basis of neurosurgeons World alliance(World Federation of Neurological Surgeons,WFNS)level 5 rating scale.Record the patients' skull CT features;initial postoperative intracranial pressure values after intraventricular external drainage,the average values of the intracranial pressure for 5 days postoperative;Records of the patient and GOS score 6months after surgery.Analysis under different conditions in patients with intracranial pressure inside 5 days if there is a difference,analyze the related factors influencing the prognosis of patients,factors that affect the initial intracranial pressure in patients with numerical analysis.Result:1 5 days postoperatively in patients with measurement of intracranial pressure in gender,age,position of aneurysm bleeding,no significant differences between groups(P>0.05),there was no statistically significantdifference between groups,and in the World Federation of Neurological Surgeons(WFNS)level 5 different hierarchical levels,initial level of intracranial pressure,prognosis and symptomatic intracranial hemorrhage cases,differences between different groups was statistically significant(P <0.05).2 Analysis of patients admitted to hospital after initial Intracranial pressure,Intracranial pressure,ICP)values and gender,age,position of aneurysm bleeding,admission GCS score,WFNS,symptomatic Intracranial bleeding,the impact on the initial Intracranial pressure,results show that the initial Intracranial pressure and admission GCS(B=-0.893,P<0.05)and WFNS score(B=2.917,P<0.05)exist linear correlation,other factors has not entered the regression equation(P> 0.05).3 Analysis after admission in patients with the intracranial pressure,numerical,gender,age,aneurysm bleeding site,admission GCS score,WFNS and symptomatic intracranial bleeding,the impact on the poor prognosis,forward by binomial logistic regression analysis method for variable selection,the results show that the initial intracranial pressure numerical value(P<0.05,OR = 1.574)and age(P<0.05,OR=1.379),are independent risk factors affect the prognosis of patients(P < 0.05).Conclusion:1 Invasive intracranial pressure monitoring for aneurysmal subarachnoid hemorrhage with provide reference for clinical treatment of patients with acute hydrocephalus.2 World Federation of Neurological Surgeons(WFNS)hierarchical level5 different level,initial level of intracranial pressure,prognosis and symptomatic intracranial hemorrhage cases,for five consecutive days of intracranial pressure monitoring data,the differences between groups was statistically significant(P<0.05),the above factors impact on patients with intracranial pressure exists.And factors such as gender,age,position of aneurysm bleeding were analyzed,and no significant differences between groups(P>0.05),the above factors have less effect on the intracranialpressure.3 To 31 patients,the initial ICP numerical were retrospectively analyzed.Initial ICP numerical value is negatively related to the admission GCS scores were(B=-0.893,P < 0.05),positive correlated with WFNS(B=2.917,P<0.05),the initial ICP number=30.807-0.893(GCS)+ 2.917(WFNS),and both the initial numerical predictive intracranial pressure.4 Factors affecting the prognosis of logistic regression analysis,and through the binomial logistic regression analysis method for variable selection forward,the results show that the initial intracranial pressure numerical value(P < 0.05,OR = 1.574)and age(P < 0.05,OR = 1.379),are independent risk factors affect the prognosis of patients(P < 0.05).