Department of ICU of Hongqiao Campus, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
World Neurosurg. 2024 Sep;189:447-455.e4. doi: 10.1016/j.wneu.2024.07.007. Epub 2024 Jul 6.
To describe the potential effects of Intracranial pressure monitoring on the outcome of patients with spontaneous intracerebral hemorrhage (ICH).
This study is a systematic review with meta-analysis. Patients with spontaneous ICH treated with intracranial pressure monitoring were included. The primary outcome was mortality at 6 months and in-hospital mortality. The secondary outcome was poor neurological function outcome at 6 months.
This analysis compares in-hospital and 6-month mortality rates between patients with intracranial pressure monitoring (ICPm) and those without (no ICPm). Although the ICPm group had a lower in-hospital mortality rate, it was not statistically significant (24.9% vs. 34.1%; OR 0.51, 95% CI 0.20 to 1.31, P = 0.16). Excluding patients with intraventricular hemorrhage revealed a significant reduction in in-hospital mortality for the ICPm group (23.5% vs. 43%; OR 0.39, 95% CI 0.29 to 0.53, P < 0.00001). For 6-month mortality, the ICPm group showed a significant reduction (32% vs. 39.6%; OR 0.76, 95% CI 0.61 to 0.94, P = 0.01), with the effect being more pronounced after excluding intraventricular hemorrhage patients (29.1% vs. 47.2%; OR 0.45, 95% CI 0.34 to 0.60, P < 0.0001). However, there were no statistically significant differences in 6-month functional outcomes between the groups. Increased ICP was associated with higher 3-month mortality (OR 1.12, 95% CI 1.07 to 1.18, P < 0.00001) and lower likelihood of good functional outcomes (OR 1.11, 95% CI 1.04 to 1.18, P < 0.00001).
Elevated ICP is associated with increased mortality and poor prognosis in ICH patients. Although continuous intracranial pressure monitoring may reduce short-term mortality rates in specific subgroups of ICH patients, it does not improve neurological functional outcomes. While potential patient populations may benefit from ICP monitoring, more research is needed to screen suitable populations for ICP monitoring.
描述颅内压监测对自发性脑出血（ICH）患者预后的潜在影响。
这是一项系统评价和荟萃分析研究。纳入接受颅内压监测治疗的自发性 ICH 患者。主要结局为 6 个月和住院死亡率。次要结局为 6 个月时神经功能不良结局。
本分析比较了颅内压监测（ICPm）组和无颅内压监测（无 ICPm）组的住院和 6 个月死亡率。尽管 ICPm 组的住院死亡率较低，但差异无统计学意义（24.9% vs. 34.1%；OR 0.51，95%CI 0.20 至 1.31，P=0.16）。排除脑室出血患者后，ICPm 组的住院死亡率显著降低（23.5% vs. 43%；OR 0.39，95%CI 0.29 至 0.53，P<0.00001）。对于 6 个月死亡率，ICPm 组有显著降低（32% vs. 39.6%；OR 0.76，95%CI 0.61 至 0.94，P=0.01），排除脑室出血患者后效果更为明显（29.1% vs. 47.2%；OR 0.45，95%CI 0.34 至 0.60，P<0.0001）。然而，两组间 6 个月功能结局无统计学差异。颅内压升高与 3 个月死亡率增加（OR 1.12，95%CI 1.07 至 1.18，P<0.00001）和良好功能结局可能性降低相关（OR 1.11，95%CI 1.04 至 1.18，P<0.00001）。
ICH 患者颅内压升高与死亡率增加和预后不良相关。虽然连续颅内压监测可能降低特定 ICH 患者亚组的短期死亡率，但不能改善神经功能结局。虽然可能有部分患者群体受益于颅内压监测，但仍需进一步研究以筛选适合颅内压监测的患者群体。
