Meixensberger Jürgen, Vath Albert, Jaeger Matthias, Kunze Ekkehard, Dings Jim, Roosen Klaus
Department of Neurosurgery, University of Leipzig, Leipzig, Johannisallee 34, D-04103 Leipzig, Germany.
Neurol Res. 2003 Jul;25(5):445-50. doi: 10.1179/016164103101201823.
The purpose of this prospective observational study was to investigate the relation between the frequency of critical neuromonitoring parameters (brain tissue pO2, (PtiO2) < or = 10 mmHg, intracranial pressure (ICP) > 20 mmHg, cerebral perfusion pressure (CPP) < or = 70 mmHg) and outcome after severe aneurysmal subarachnoid hemorrhage (SAH). In a prospective study on 42 patients monitoring of ICP, CPP, and PtiO2 (in the area at risk for vasospasm) was performed. All patients were primarily classified as Hunt and Hess grade 4 or with secondary deterioration to this grade. Relative proportions of PtiO2 < or = 10 mmHg (n = 42), ICP > 20 mmHg (n = 25) and CPP < or = 70 mmHg (n = 23) were derived from multimodal neuromonitoring data sets for different time intervals, i.e. 1. the total monitoring time; 2. the total monitoring time without the last two monitoring days; 3. the second last monitoring day; and 4. the last monitoring day. Patients were divided into nonsurvivors (GOS = 1) and survivors (GOS = 3-5). For the total monitoring time, significant differences in the relative proportion of critical values were found for all neuromonitoring parameters (p < 0.05). The detailed analysis of consecutive time intervals revealed significantly increased proportions of critical values in nonsurvivors for all neuromonitoring parameters during the last day only. Additionally, ICP > 20 mmHg was significantly more frequent during the second last day (p < 0.01). For other time periods no differences were observed. We conclude, that critical neuromonitoring values are not early predictors of nonsurvival in patients suffering from severe SAH.
这项前瞻性观察性研究的目的是调查严重动脉瘤性蛛网膜下腔出血（SAH）后关键神经监测参数（脑组织氧分压（PtiO2）≤10 mmHg、颅内压（ICP）>20 mmHg、脑灌注压（CPP）≤70 mmHg）的频率与预后之间的关系。在一项针对42例患者的前瞻性研究中，对ICP、CPP和PtiO2（在血管痉挛风险区域）进行了监测。所有患者最初主要被分类为Hunt和Hess 4级或继发恶化为此级别。PtiO2≤10 mmHg（n = 42）、ICP>20 mmHg（n = 25）和CPP≤70 mmHg（n = 23）的相对比例来自不同时间间隔的多模态神经监测数据集，即1. 总监测时间；2. 不包括最后两个监测日的总监测时间；3. 倒数第二个监测日；4. 最后一个监测日。患者分为非幸存者（GOS = 1）和幸存者（GOS = 3 - 5）。对于总监测时间，所有神经监测参数的临界值相对比例均存在显著差异（p < 0.05）。对连续时间间隔的详细分析显示，仅在最后一天，所有神经监测参数在非幸存者中的临界值比例显著增加。此外，在倒数第二天，ICP>20 mmHg的情况显著更频繁（p < 0.01）。在其他时间段未观察到差异。我们得出结论，关键神经监测值不是严重SAH患者非生存的早期预测指标。
