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目的:目前无创颅内压监测仪尚未在临床得到广泛和熟练应用,总结无创颅内压监测仪临床应用中的N2波形特点,为今后的工作提供指导意义。方法:①实验对象:选取2006-01/2007-01珠江医院神经外科住院颅脑损伤患者50例,分成3组,其中颅内血肿急诊手术组20例,颅内血肿保守治疗后加重再手术组10例,颅内血肿保守治疗组20例,以及正常对照组20例。均对本实验知情同意。②主要实验仪器:应用MICP-1A型无创颅内压监测仪(重庆名希公司),闪光眼罩,所产生的光源为蓝色氖光,闪光刺激频率1.0Hz,闪光脉冲宽度2ms,闪光次数70次(1次/s),枕部电极和额部电极。③实验评估:前两组分别监测手术前后颅内压闪光视觉诱发电位值,共3次,后两组在相应时间分别测定闪光视觉诱发电位值,每次监测颅内压后即刻腰穿测定颅内压进行对照。闪光视觉诱发电位颅内压监测时,15min内连续3遍测定闪光视觉诱发电位值并记录,取平均值,分析所记录240幅闪光视觉诱发电位的N2波,总结N2波特点,比较同一测试者随着颅内压的改变闪光视觉诱发电位值的变化情况。结果:闪光视觉诱发电位的N2波监测的颅内压结果和腰椎穿刺测定的颅内压结果等效(P>0.05),设定等效界值为0.098kPa(10mmH2O)。颅内血肿组闪光视觉诱发电位值均高于正常对照组(P<0.05)。在同一测试者,多次测量也可得出不同的波形,N2波的变化趋势稳定,N2波波幅与颅内压无关,N2波较宽,其波形的一个主要特点是前后均有较深的P波。颅内压越高N2波潜伏期越长。结论:闪光视觉诱发电位的值和腰穿测定颅内压结果基本接近,可以直接反应出颅内压的改变趋势,尽管N2波形变化较大,但是还是有规律可循,N2波的中点潜伏期可以作为测量颅内压的依据。
Objective: At present, the noninvasive intracranial pressure monitor has not been widely and skillfully applied in clinical practice. The characteristics of N2 waveform in clinical application of noninvasive intracranial pressure monitor are summarized, which will provide the guiding significance for the future work. Methods: ①Experimental subjects: Fifty patients with craniocerebral injury in Department of Neurosurgery, Zhujiang Hospital, 2006-01 / 2007-01 were divided into three groups, of which 20 were intracranial hematoma emergency surgery group and severe reoperation after intracranial hematoma conservative treatment 10 cases, 20 cases of conservative treatment of intracranial hematoma and 20 cases of normal control group. Informed consent to this experiment. The main experimental equipment: the use of MICP-1A noninvasive intracranial pressure monitor (Chongqing Ming Greek company), flash goggles, the resulting light source is blue neon light flash stimulation frequency 1.0Hz, flash pulse width 2ms, the number of flashes 70 Times (1 time / s), occipital electrodes and forehead electrodes. ③ experimental evaluation: the first two groups were monitored before and after intracranial pressure flash visual evoked potentials, a total of 3 times, respectively, after the two groups were measured at the appropriate time flash visual evoked potentials, each time monitoring intracranial pressure lumbar puncture determination of the skull Internal pressure control. Flash visual evoked potentials intracranial pressure monitoring, 15min three consecutive times to determine the value of flash visual evoked potential and recorded, averaged, recorded 240 flash visual evoked potentials N2 wave, summary of N2 wave characteristics, compared with the same tester With the change of intracranial pressure flash visual evoked potential changes. Results: The results of intracranial pressure monitoring by flash wave visual evoked potentials (N2 wave) were equivalent to those by lumbar puncture (P> 0.05). The equivalent cutoff was 0.098 kPa (10 mmH2O). The intracranial hematoma group flash visual evoked potentials were higher than the normal control group (P <0.05). In the same tester, multiple measurements can also be drawn different waveforms, N2 wave trends stable, N2 wave amplitude and intracranial pressure has nothing to do, N2 wave is wider, one of its main features of the waveform are deep before and after P wave. Higher intracranial pressure N2 wave longer latency. CONCLUSION: The value of flash visual evoked potentials is close to that of lumbar puncture, which can directly reflect the changing trend of intracranial pressure. Although the variation of N2 waveform is larger, it still has a regular pattern. The midpoint latency of N2 wave Can be used as a basis for measuring intracranial pressure.