Schrieff-Elson L E, Thomas K G F, Rohlwink U K, Figaji A A
ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa.
Division of Neurosurgery, Department of Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
Childs Nerv Syst. 2015 Dec;31(12):2257-68. doi: 10.1007/s00381-015-2892-2. Epub 2015 Sep 4.
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. Preventing secondary injury by controlling physiological parameters (e.g. intracranial pressure [ICP], cerebral perfusion pressure [CPP] and brain tissue oxygen [PbtO2]) has a potential to improve outcome. Low PbtO2 is independently associated with poor clinical outcomes in both adults and children. However, no studies have investigated associations between low PbtO2 and neuropsychological and behavioural outcomes following severe pediatric TBI (pTBI).
We used a quasi-experimental case-control design to investigate these relationships. A sample of 11 TBI patients with a Glasgow Coma Scale score ≤8 who had PbtO2 and ICP monitoring at the Red Cross War Memorial Children's Hospital underwent neuropsychological evaluation ≥1 year post-injury. Their performance was compared to that of 11 demographically matched healthy controls. We then assigned each TBI participant into one of two subgroups, (1) children who had experienced at least one episode of PbtO2 ≤ 10 mmHg or (2) children for whom PbtO2 > 10 mmHg throughout the monitoring period, and compared their results on neuropsychological evaluation.
TBI participants performed significantly more poorly than controls in several cognitive domains (IQ, attention, visual memory, executive functions and expressive language) and behavioural (e.g. externalizing behaviour) domains. The PbtO2 ≤ 10 mmHg group performed significantly worse than the PbtO2 > 10 mmHg group in several cognitive domains (IQ, attention, verbal memory, executive functions and expressive language), but not on behavioural measures.
Results demonstrate that low PbtO2 may be prognostic of not only mortality but also neuropsychological outcomes.
创伤性脑损伤（TBI）是儿童发病和死亡的主要原因。通过控制生理参数（如颅内压[ICP]、脑灌注压[CPP]和脑组织氧分压[PbtO2]）预防继发性损伤有可能改善预后。低PbtO2与成人和儿童的不良临床结局独立相关。然而，尚无研究调查严重儿童创伤性脑损伤（pTBI）后低PbtO2与神经心理和行为结局之间的关联。
我们采用准实验性病例对照设计来研究这些关系。对11名格拉斯哥昏迷量表评分≤8分、在红十字战争纪念儿童医院接受PbtO2和ICP监测的TBI患者进行了伤后≥1年的神经心理评估。将他们的表现与11名人口统计学匹配的健康对照者进行比较。然后，我们将每名TBI参与者分为两个亚组之一：（1）经历过至少一次PbtO2≤10 mmHg的儿童，或（2）在整个监测期内PbtO2>10 mmHg的儿童，并比较他们在神经心理评估中的结果。
TBI参与者在几个认知领域（智商、注意力、视觉记忆、执行功能和表达性语言）和行为（如外化行为）领域的表现明显比对照组差。PbtO2≤10 mmHg组在几个认知领域（智商、注意力、言语记忆、执行功能和表达性语言）的表现明显比PbtO2>10 mmHg组差，但在行为指标上没有差异。
结果表明，低PbtO2不仅可能是死亡率的预后指标，也是神经心理结局的预后指标。
