创伤性脑损伤与显著的心肌功能障碍无关：一项观察性试点研究。
Traumatic brain injury is not associated with significant myocardial dysfunction: an observational pilot study.
作者信息
Serri Karim, El Rayes Malak, Giraldeau Geneviève, Williamson David, Bernard Francis
机构信息
Département de médecine, Hôpital du Sacré-Coeur de Montréal, Service de soins intensifs, Université de Montréal, 5400, boul Gouin ouest, Montréal, H4J-1C5, Canada.
Centre de recherche Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada.
出版信息
Scand J Trauma Resusc Emerg Med. 2016 Mar 16;24:31. doi: 10.1186/s13049-016-0217-4.
BACKGROUND
Myocardial dysfunction has been well described with catastrophic neurological events, such as subarachnoid hemorrhage and brain death. There is very limited data describing myocardial function in the context of traumatic brain injury (TBI), as no prospective study has yet examined this association. The objective of our study was to evaluate cardiac function using echocardiography in patients with clinically important TBI.
METHODS
We conducted a prospective observational study of consecutive TBI patients admitted to the intensive care unit. All patients older than 16 years with moderate to severe TBI according to the Glascow Coma Scale (GCS) were eligible for the study. Only patients with a prior history of heart disease or cardiomyopathy or evidence of brain death on admission were excluded. A complete transthoracic echocardiogram was performed within 4 days of admission.
RESULTS
Forty-nine patients (67% males, median age 34 years) were included in the study. Forty-one patients had severe TBI (84%) with a median GCS of six, 44 patients (90%) required mechanical ventilation and 36 (74%) intracranial pressure monitoring. Hospital mortality was 18%. No patients had global left ventricular dysfunction as defined by a left ventricular ejection fraction (LVEF) below 50% (95% CI, 0-0.07). Average LVEF was 65 +/- 4%. Four patients (8%) had regional wall motion abnormalities with preserved LVEF.
DISCUSSION
The main finding of this study is the absence of clinically significant myocardial dysfunction in patients with moderate or severe TBI. Although myocardial dysfunction has been well described in a variety of neurological settings, it is possible that the young age of TBI patients and the absence of cardiovascular risk factors are protective against significant myocardial injury from catecholamine excess.
CONCLUSIONS
In a group of patients with clinically important TBI, we did not identify any significant cardiac dysfunction.
背景
心肌功能障碍在灾难性神经系统事件（如蛛网膜下腔出血和脑死亡）中已有充分描述。在创伤性脑损伤（TBI）背景下描述心肌功能的数据非常有限，因为尚无前瞻性研究探讨这种关联。我们研究的目的是使用超声心动图评估具有临床重要性的TBI患者的心脏功能。
方法
我们对入住重症监护病房的连续TBI患者进行了一项前瞻性观察研究。所有年龄大于16岁、根据格拉斯哥昏迷量表（GCS）为中度至重度TBI的患者均符合研究条件。仅排除入院时有心脏病或心肌病病史或脑死亡证据的患者。入院后4天内进行完整的经胸超声心动图检查。
结果
49例患者（67%为男性，中位年龄34岁）纳入研究。41例患者为重度TBI（84%），中位GCS为6分，44例患者（90%）需要机械通气，36例（74%）需要颅内压监测。医院死亡率为18%。没有患者出现左心室射血分数（LVEF）低于50%定义的整体左心室功能障碍（95%CI，0 - 0.07）。平均LVEF为65±4%。4例患者（8%）出现节段性室壁运动异常但LVEF保留。
讨论
本研究的主要发现是中度或重度TBI患者不存在具有临床意义的心肌功能障碍。虽然在多种神经学情况下心肌功能障碍已有充分描述，但TBI患者年轻且无心血管危险因素可能对儿茶酚胺过量导致的显著心肌损伤具有保护作用。
结论
在一组具有临床重要性的TBI患者中，我们未发现任何显著的心脏功能障碍。
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