Guyot L L, Dowling C, Diaz F G, Michael D B
Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
Acta Neurochir Suppl. 1998;71:47-9. doi: 10.1007/978-3-7091-6475-4_15.
The use of indwelling cerebral monitoring devices (ICMDs) is common in the intensive care of neurosurgical patients. ICMDs are used to measure and treat intracranial pressure (ICP), temperature, blood flow and the microchemical environment. Intracranial hemorrhage (ICH) and infection are risks of ICMD use [4]. This study presents ICMD use at Detroit Receiving Hospital (DRH) from July 1993- March 1997. Analysis of complications associated with ICMD placement will test the hypothesis that complication rate depends upon type of ICMD used. A log of all patients having ICMDs at DRH has been kept since 1993. This log was used to identify complications of ICMD placement. Each case was reviewed and the following data obtained: diagnosis, patient age, initial Glasgow Coma Score, Glasgow Outcome Score, type of ICMD, number of ICMDs per patient, duration of implant and complication. Descriptive and non-parametric statistics were used to compare samples of interest. The following number of ICMDs were placed: 274 ventriculostomies, 229 Camino intra parenchymal ICP monitors, and 33 other ICMDs. Complications in these 536 cases include 21 infections, 15 ICHs, 1 granuloma and 1 persistent cerebrospinal fluid leak. Complication was analyzed as a function of ICMD type using Chi-Square test for independence. The rate of infection and ICH was significantly higher in the ventriculostomy group (p = 0.0001). These results support the hypothesis that complications of ICMD use are due to the type of device implanted. The determinants of ICMD complication is undoubtedly multifactorial. The clinician must consider the complication rate related to a particular ICMD among other factors when choosing to place an ICMD.
留置脑监测设备（ICMDs）在神经外科患者的重症监护中应用广泛。ICMDs用于测量和治疗颅内压（ICP）、体温、血流及微化学环境。颅内出血（ICH）和感染是使用ICMDs的风险[4]。本研究呈现了1993年7月至1997年3月期间底特律接收医院（DRH）使用ICMDs的情况。对与ICMDs置入相关并发症的分析将检验并发症发生率取决于所用ICMD类型这一假设。自1993年起，DRH就保存了所有使用ICMDs患者的记录。该记录用于识别ICMDs置入的并发症。对每个病例进行了回顾并获取了以下数据：诊断、患者年龄、初始格拉斯哥昏迷评分、格拉斯哥预后评分、ICMD类型、每位患者的ICMD数量、植入持续时间及并发症情况。采用描述性和非参数统计来比较感兴趣的样本。共置入了以下数量的ICMDs：274个脑室造瘘管、229个Camino脑实质内ICP监测仪及33个其他ICMDs。这536例病例中的并发症包括21例感染、15例ICH、1例肉芽肿和1例持续性脑脊液漏。使用卡方独立性检验分析并发症与ICMD类型的关系。脑室造瘘组的感染率和ICH率显著更高（p = 0.0001）。这些结果支持了使用ICMDs的并发症是由所植入设备类型导致的这一假设。ICMD并发症的决定因素无疑是多因素的。临床医生在选择置入ICMD时，必须在其他因素中考虑与特定ICMD相关的并发症发生率。
