Zeng Jingsong, Zheng Ping, Tong Wusong, Fang Weimin
Department of Neurosurgery, Shanghai Pudong New area People's Hospital, 490 South Chuanhuan Road, Shanghai, China.
BMC Anesthesiol. 2014 Mar 21;14:19. doi: 10.1186/1471-2253-14-19.
Intracranial-pressure (ICP) monitoring is considered standard care for severe traumatic brain injury and is used frequently, but the efficacy of treatment based on monitoring in patients with hemorrhagic stroke has not been rigorously assessed. In this study, we investigated the clinical value of ICP monitoring in patients with hemorrhagic stroke.
We conducted a randomized, unblinded, controlled trial in which 90 patients with hemorrhagic stroke were randomly assigned to ICP monitoring or a control group. The primary outcome was a composite of incidence rate of hematoma enlargement and secondary brain herniation. The secondary outcome was neurological status assessed using the Glasgow Outcome Scale scores at 6 months post-onset. Characteristics of the patients at baseline and outcome measurements were also compared between the two groups.
There was no significant between-group difference in the incidence of hematoma enlargement (control group, 38.6% vs. ICP monitoring group, 32.6%; P > 0.05). The incidence rate of secondary brain herniation in the ICP monitoring group was significantly lower compared with the control group (10.9% vs. 20.5%, P = 0.04). Six-month mortality was 6.5% in the ICP group and 9.1% in the control group (P < 0.05), and neurological outcome was better in the ICP group compared with the control group (P < 0.05).
The dynamic ICP value may be more sensitive and effective in preventing secondary brain herniation in patients with hemorrhagic stroke compared with guidance directed by clinical signs and radiological indicators.
颅内压（ICP）监测被认为是重度创伤性脑损伤的标准治疗手段且应用频繁，但基于监测的治疗方法对出血性脑卒中患者的疗效尚未得到严格评估。在本研究中，我们调查了ICP监测对出血性脑卒中患者的临床价值。
我们进行了一项随机、非盲、对照试验，将90例出血性脑卒中患者随机分为ICP监测组或对照组。主要结局是血肿扩大和继发性脑疝形成的发生率。次要结局是发病6个月时使用格拉斯哥预后量表评分评估的神经功能状态。还比较了两组患者基线时的特征和结局指标。
血肿扩大的发生率在两组间无显著差异（对照组为38.6%，ICP监测组为32.6%；P>0.05）。ICP监测组继发性脑疝的发生率显著低于对照组（10.9%对20.5%，P=0.04）。ICP组6个月死亡率为6.5%，对照组为9.1%（P<0.05），且ICP组的神经功能结局优于对照组（P<0.05）。
与临床体征和影像学指标指导相比，动态ICP值在预防出血性脑卒中患者继发性脑疝方面可能更敏感、有效。
