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目的探讨脑积水患儿不同术式治疗后颅内压(intracranial pressure,ICP)的改变及其临床意义。方法回顾性分析我科2011年1月至2012年12月住院手术治疗的29例脑积水患儿围手术期的ICP变化,其中分流手术14例,脑室镜下三脑室底造瘘术(endoscopic third ventriculostomy,ETV)15例。使用脑实质型ICP探头在手术前后连续监测ICP的变化,监测时间72~168 h。结果与术前比较,两组术后ICP均有明显下降(P<0.05)。术后连续监测显示两手术组ICP变化明显不同,分流手术组ICP呈持续下降趋势,ETV组ICP术后迅速回升,再呈缓慢下降趋势。可调压管分流组术后24 h内回升到接近术前的水平,此后120 h内逐渐下降至调压阀设定的压力水平。脑室镜手术组术后24~48 h内可出现一过性高颅压,其中肿瘤继发脑积水亚组较先天性脑积水亚组明显,持续时间更长。结论 ICP监测能准确反映脑积水患儿围手术期颅压变化,术后持续监测有助于准确判断ETV的手术效果。
Objective To investigate the changes of intracranial pressure (ICP) in children with hydrocephalus after different surgical procedures and their clinical significance. Methods The perioperative ICP changes of 29 patients with hydrocephalus admitted to our hospital from January 2011 to December 2012 were retrospectively analyzed. Among them, 14 were shunt operation, endoscopic third ventriculostomy, ETV) 15 cases. The use of brain parenchyma ICP probe before and after continuous monitoring of ICP changes in monitoring time 72 ~ 168 h. Results Compared with preoperative, the postoperative ICP of both groups decreased significantly (P <0.05). Continuous postoperative monitoring showed that the ICP changes were significantly different between the two groups. The ICP in the shunt group continued to decline. The ETV group rose rapidly after ICP and then decreased slowly. Adjustable tube shunt group within 24 h after surgery rose back to preoperative level, then gradually decreased within 120 h to the pressure regulator set pressure level. Transcranial intracranial pressure may occur within 24-48 hours after operation in the intracerebral microscopy group, in which the subgroup of secondary hydrocephalus was significantly longer than that of congenital hydrocephalus. Conclusion ICP monitoring can accurately reflect perioperative intracranial pressure changes in children with hydrocephalus, continuous monitoring helps to accurately determine the effect of ETV surgery.