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颅内压监测辅助治疗与高血压相关性自发性脑出血患者的良好预后相关。

Intracranial Pressure Monitoring-Aided Management Associated with Favorable Outcomes in Patients with Hypertension-Related Spontaneous Intracerebral Hemorrhage.

机构信息

Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.

Department of Neurosurgery, Tibet Autonomous Region People's Hospital, Lhasa, Tibet, China.

出版信息

Transl Stroke Res. 2020 Dec;11(6):1253-1263. doi: 10.1007/s12975-020-00798-w. Epub 2020 Mar 6.

Abstract

To investigate the effect of intracranial pressure (ICP) monitoring on the functional outcome of patients with hypertension-related spontaneous intracerebral hemorrhage (ICH). We included 196 patients with Glasgow Coma Scale (GCS) scores of 3-12 in this observational study, of which 103 underwent ICP monitors. Binary and ordinal regression analyses were used to estimate the effect of ICP monitoring on the functional outcome. The rate of adverse events, blood pressure control, and length of hospitalization were compared between the two groups. ICP monitoring had a significant impact on the clinical outcome of patients by shifting the Extended Glasgow Outcome Scale (GOS-E) scores in a favorable direction (p = 0.027) and reducing mortality at discharge (p = 0.004) and 6 months later (p = 0.02). The rate of favorable outcome at 6 months was higher in the ICP-monitored group (p = 0.03). However, subgroup analysis showed that no relationship between ICP monitoring and clinical outcome was found for patients with GCS scores of 3-8. For patients with GCS scores of 9-12, the distribution of GOS-E scores at 6 months shifted in a favorable direction in the ICP-monitored group (p = 0.001). The rate of favorable outcome at 6 months was higher in the ICP-monitored group (p = 0.01). The mortality at discharge and 6 months later was also lower in the ICP-monitored group. Thus, our study supports the value of ICP monitoring in hypertension-related ICH patients with GCS scores of 3-12, especially those with GCS scores of 9-12.

摘要

为了探究颅内压(ICP)监测对高血压相关性自发性脑出血(ICH)患者功能结局的影响。我们进行了一项观察性研究,纳入了 196 名格拉斯哥昏迷量表(GCS)评分为 3-12 分的患者,其中 103 名患者接受了 ICP 监测。我们采用二项和有序回归分析来评估 ICP 监测对功能结局的影响。比较了两组患者的不良事件发生率、血压控制情况和住院时间。ICP 监测对患者的临床结局有显著影响,使扩展格拉斯哥预后量表(GOS-E)评分向有利方向转移(p=0.027),降低了出院时(p=0.004)和 6 个月后(p=0.02)的死亡率。6 个月时 ICP 监测组的良好预后率更高(p=0.03)。但是,亚组分析显示,对于 GCS 评分为 3-8 分的患者,ICP 监测与临床结局之间无相关性。对于 GCS 评分为 9-12 分的患者,6 个月时 GOS-E 评分的分布在 ICP 监测组中向有利方向转移(p=0.001)。6 个月时 ICP 监测组的良好预后率更高(p=0.01)。出院时和 6 个月后的死亡率也较低。因此,我们的研究支持 ICP 监测在 GCS 评分为 3-12 分的高血压相关性 ICH 患者中的价值,尤其是 GCS 评分为 9-12 分的患者。

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