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一家社区医院开展脑微透析的情况:一项5年回顾性分析。

Implementation of cerebral microdialysis at a community-based hospital: A 5-year retrospective analysis.

作者信息

Chen Jeff W, Rogers Shana L, Gombart Zoe J, Adler David E, Cecil Sandy

机构信息

Department of Neurosurgery, Legacy Emanuel Medical Center, 2801 N. Gantenbein St., Portland, OR 97227, USA.

出版信息

Surg Neurol Int. 2012;3:57. doi: 10.4103/2152-7806.96868. Epub 2012 May 31.

Abstract

BACKGROUND

Cerebral microdialysis (MD) provides valuable information about brain metabolism under normal and pathologic conditions. The CMA 600 microdialysis analyzer received US Food and Drug Administration (FDA) approval for clinical use in the United States in 2005. Since then, cerebral MD has been increasingly utilized nationally in the multimodal monitoring of traumatic brain injury (TBI), stroke, aneurysmal subarachnoid hemorrhage, and brain tumors. We describe a 5-year, single-institutional experience using cerebral MD at a community-based hospital, Legacy Emanuel Medical Center (LEMC). Implications for the adoption and utility of MD in medical centers with limited resources are discussed.

METHODS

This is a retrospective chart review and data analysis of 174 consecutive patients who had cerebral MD as part of multimodal brain monitoring. All cerebral MD catheters were placed by board-certified, attending neurosurgeons at LEMC. Clinical severity in the TBI patients was reported using initial Glasgow Coma Scale (GCS); radiologic severity was graded with the Marshall CT grading scale. Measures of the risks of MD placement included post-placement hemorrhage, cerebral infection, and dislodgement.

RESULTS

Between July 2005 and July 2010, 248 cerebral MD catheters were placed in 174 patients undergoing multimodal brain monitoring. One hundred and eighty-five catheters were placed at the time of open craniotomy. None were associated with cranial infection. Patients ranged in age from 5 months to 90 years, with a mean of 49 years. The male to female ratio was 1.4:1. The underlying pathologies were: TBI (126), cerebral vascular accident (24), aneurysmal subarachnoid hemorrhage (17), and tumor (7).

CONCLUSIONS

Cerebral MD was readily implemented in a community-based hospital. No cerebral hemorrhages or infections were attributed to cerebral MD. Examples of how MD may be a useful adjunct in the clinical decision making of patients with brain injuries are presented.

摘要

背景

脑微透析(MD)可提供有关正常及病理状态下脑代谢的宝贵信息。CMA 600微透析分析仪于2005年获得美国食品药品监督管理局(FDA)批准在美国用于临床。自那时起,脑MD在全国范围内越来越多地被用于创伤性脑损伤(TBI)、中风、动脉瘤性蛛网膜下腔出血和脑肿瘤的多模式监测。我们描述了在一家社区医院——遗产伊曼纽尔医疗中心(LEMC)使用脑MD的5年单机构经验。讨论了在资源有限的医疗中心采用MD及其效用的相关问题。

方法

这是一项对174例连续患者的回顾性病历审查和数据分析,这些患者接受了脑MD作为多模式脑监测的一部分。所有脑MD导管均由LEMC经委员会认证的主治神经外科医生放置。TBI患者的临床严重程度用初始格拉斯哥昏迷量表(GCS)报告;放射学严重程度用马歇尔CT分级量表分级。MD放置的风险指标包括放置后出血、脑感染和移位。

结果

2005年7月至2010年7月期间,在174例接受多模式脑监测的患者中放置了248根脑MD导管。185根导管在开颅手术时放置。无一例与颅内感染相关。患者年龄从5个月至90岁不等,平均年龄49岁。男女比例为1.4:1。潜在病因包括:TBI(126例)、脑血管意外(24例)、动脉瘤性蛛网膜下腔出血(17例)和肿瘤(7例)。

结论

脑MD在一家社区医院很容易实施。未发现脑出血或感染归因于脑MD。本文介绍了MD在脑损伤患者临床决策中如何作为有用辅助手段的实例。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/22dd/3385066/9342d3c9c2f5/SNI-3-57-g001.jpg

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