Eide P K, Fremming A D
Department of Neurosurgery, The National Hospital, University of Oslo, Sensometrics AS, Oslo, Norway.
Acta Neurochir (Wien). 2003 May;145(5):351-7; discussion 357-8. doi: 10.1007/s00701-003-0029-y.
This study assessed two strategies of comparing continuous intracranial pressure (ICP) recordings within individual cases, namely either by calculation of differences in mean ICP or by calculation of differences in numbers of ICP elevations.
Continuous ICP recordings before and after cranial surgery were both presented as mean ICP and as numbers of ICP elevations of different levels (20 and 25 mmHg lasting either 0.5 or 1 minute). Since the length of pressure recordings differed somewhat between individuals, the numbers of ICP elevations were standardised by computing the numbers of elevations during a 10 hours period. The ICP recordings were analysed by the Sensometrics Pressure Analyser software. The ICP curves included here were selected from a group of 15 children undergoing calvarial expansion surgery for craniosynostosis, in whom continuous ICP monitoring was performed both before and after surgery as part of the diagnostic workout to rule out lasting intracranial hypertension.
After surgery, mean ICP during sleep was reduced by 5 mmHg or more in 5 cases, minimally changed (i.e. 2 mmHg or less) in 6 cases, and variably increased in the other 4 cases. In one of these 4 latter cases, numbers of ICP elevations were increased after surgery, but in all other 14 cases the numbers of ICP elevations were significantly reduced. Reduction of mean ICP by more than 2 mmHg associated with good outcome was observed in 3 of 15 cases (20%), whereas marked and significant reductions in numbers of ICP elevations during sleep combined with good outcome was observed in 12 of 15 cases (80%).
Outcome after the 2nd ICP monitoring was more reliably predicted by computing differences in numbers of ICP elevations than by calculation of mean ICP.
本研究评估了在个体病例中比较连续颅内压（ICP）记录的两种策略，即通过计算平均ICP的差异或通过计算ICP升高次数的差异。
颅骨手术前后的连续ICP记录均以平均ICP以及不同水平（20和25 mmHg，持续0.5或1分钟）的ICP升高次数呈现。由于个体间压力记录的时长略有不同，通过计算10小时内的升高次数对ICP升高次数进行标准化。ICP记录由感觉测量压力分析仪软件进行分析。此处纳入的ICP曲线选自15名因颅缝早闭接受颅骨扩张手术的儿童，在这些儿童中，手术前后均进行了连续ICP监测，作为排除持续性颅内高压诊断检查的一部分。
术后，5例患者睡眠期间的平均ICP降低了5 mmHg或更多，6例患者变化极小（即2 mmHg或更少），另外4例患者则有不同程度的升高。在这4例后者中的1例中，术后ICP升高次数增加，但在所有其他14例中，ICP升高次数均显著减少。15例中有3例（20%）观察到平均ICP降低超过2 mmHg且预后良好，而15例中有12例（80%）观察到睡眠期间ICP升高次数显著减少且预后良好。
通过计算ICP升高次数的差异比计算平均ICP能更可靠地预测第二次ICP监测后的预后。
