Lv Yuhua, Wang Dayan, Lei Jin, Tan Ge
Department of Neurology, Chongqing Banan Hospital, Chongqing, 401320, China,
Neurol Sci. 2015 Jul;36(7):1203-10. doi: 10.1007/s10072-015-2073-9. Epub 2015 Jan 22.
The time course of intracranial pressure (ICP) after subarachnoid hemorrhage (SAH) is not well known. This retrospective study was conducted to investigate the occurrence and the dynamic variation of raised ICP post-SAH. ICP was prospectively studied in 120 patients with SAH who were admitted to neurocritical care within 24 h of hemorrhage. Patients underwent continuous ICP monitoring for at least 7 days, unless they died. Clinical status on admission, radiographic tests, treatment details and neurological outcome on discharge were analyzed in relation to ICP. The highest daily mean ICP and the day when ICP reduced to normal levels were assessed. Of the 120 patients studied, 112 (93.3 %) encountered ICP elevation whilst in hospital. The daily mean ICP was higher in Hunt and Hess grades IV-V patients than grades I-III patients (P = 0.01). The elevated ICP remained at a higher level for the initial 3 days (grades I-III patients) or 4 days (grades IV-V patients), after which the pressure decreased towards normal levels. The in-patient mortality was significantly increased in the high ICP variability group (P = 0.001), which was divided by the cutoff point using receiver operating characteristic curve analysis. Raised ICP mainly occurs within 8 days post-SAH, especially the initial 3-4 days. Those highlight the need for earlier management of ICP after SAH.
蛛网膜下腔出血（SAH）后颅内压（ICP）的时间进程尚不清楚。本回顾性研究旨在调查SAH后ICP升高的发生情况及动态变化。对120例SAH患者进行前瞻性研究，这些患者在出血后24小时内入住神经重症监护病房。患者接受至少7天的连续ICP监测，除非死亡。分析入院时的临床状况、影像学检查、治疗细节及出院时的神经功能转归与ICP的关系。评估每日平均ICP最高值及ICP降至正常水平的日期。在120例研究患者中，112例（93.3%）在住院期间出现ICP升高。Hunt和Hess分级IV - V级患者的每日平均ICP高于I - III级患者（P = 0.01）。ICP升高在最初3天（I - III级患者）或4天（IV - V级患者）保持在较高水平，之后压力向正常水平下降。通过受试者工作特征曲线分析确定临界点划分的高ICP变异性组的住院死亡率显著增加（P = 0.001）。ICP升高主要发生在SAH后8天内，尤其是最初3 - 4天。这些结果凸显了SAH后早期管理ICP的必要性。
