Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington.
J Neurosci Res. 2018 Apr;96(4):661-670. doi: 10.1002/jnr.24100. Epub 2017 Jun 2.
Systolic dysfunction was recently described following traumatic brain injury (TBI), and systemic inflammation may be a contributing mechanism. Our aims were to 1) examine the association between the early systemic inflammatory response syndrome (SIRS) and systolic cardiac dysfunction following TBI, and 2) describe the longitudinal change in SIRS criteria, cardiac function, and hemodynamic parameters during the first week of hospitalization. We used a secondary analysis of a prospective cohort study examining cardiac function (with transthoracic echocardiography on the first day and serially over the first week of hospitalization) in 32 moderate-severe isolated TBI patients, and quantified the admission and daily SIRS response to injury. We determined the association of admission SIRS and systolic dysfunction following TBI. Admission SIRS was present in 7 (21%) patients and was associated with systolic dysfunction on multivariable analysis (relative risk 4.01; 95% 1.16-13.79, p = .028). Both SIRS criteria and systolic cardiac function improved over the first week of hospitalization. In conclusion, early SIRS is common among patients with moderate-severe TBI, and the presence of SIRS criteria on admission is associated with systolic cardiac dysfunction following TBI.
最近描述了创伤性脑损伤（TBI）后的收缩功能障碍，全身炎症可能是一个促成机制。我们的目的是 1）检查创伤性脑损伤后早期全身炎症反应综合征（SIRS）与收缩性心脏功能障碍之间的关联，2）描述在住院期间的第一周内 SIRS 标准、心脏功能和血液动力学参数的纵向变化。我们使用了一项前瞻性队列研究的二次分析，该研究检查了 32 例中度至重度孤立性 TBI 患者的心脏功能（在第一天进行经胸超声心动图检查，并在住院期间的第一周内进行连续检查），并量化了入院和每日 SIRS 对损伤的反应。我们确定了入院 SIRS 与 TBI 后收缩功能障碍的关联。7 例（21%）患者存在入院 SIRS，多变量分析显示 SIRS 与收缩功能障碍相关（相对风险 4.01；95%置信区间 1.16-13.79，p=0.028）。SIRS 标准和收缩性心脏功能在住院期间的第一周内均有所改善。总之，中度至重度 TBI 患者中 SIRS 很常见，入院时存在 SIRS 标准与 TBI 后收缩性心脏功能障碍相关。
