Dabrowski Wojciech, Schlegel Todd T, Wosko Jaroslaw, Rola Radoslaw, Rzecki Ziemowit, Malbrain Manu L N G, Jaroszynski Andrzej
Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Poland.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden and Nicollier-Schlegel SARL, Trélex, Switzerland.
J Electrocardiol. 2018 May-Jun;51(3):499-507. doi: 10.1016/j.jelectrocard.2017.12.038. Epub 2017 Dec 23.
Traumatic brain injury (TBI) affects cardiac electrical function, and several extra-cerebral factors, including intra-abdominal pressure (IAP), might further modulate this brain-heart interaction. The purpose of this study was to investigate the impact of TBI, and of increased IAP during TBI, on cardiac electrical function as measured by vectorcardiographic (VCG) variables.
Survival, IAP and changes in VCG variables including spatial QRS-T angle and QTc interval were measured in consecutive adult patients with either isolated TBI (iTBI), or with TBI accompanied by polytrauma to the abdomen and/or limbs (pTBI). For all patients, observations were performed just after the admission to the ICU (baseline) and at 24, 48, 72 and 96 h after admission.
74 patients aged 45 ± 18 were studied. 44 were treated for iTBI and 30 for pTBI. In all patients, spatial QRS-T angle and QTc interval increased after TBI (p < 0.001), relatively more so in patients with pTBI. Compared to survivors, non-survivors also ultimately had greater widening of the spatial QRS-T angle (p < 0.001), most notably just before foraminal herniation. Wider spatial QRS-T angle and longer QTc interval were also noted in patients with IAP > 12 mmHg (p < 0.001), and with right compared to left hemispheric injury (p < 0.001). ST segment level at the J point decreased 24 and 48 h after TBI in leads I, II, III, aVR, aVF, V1, V2, V3 and V6, and increased in lead V1, especially in non-survivors.
Spatial QRS-T angle and QTc interval increase after TBI. If foraminal herniation complicates TBI, further widening of the spatial QRS-T angle typically precedes it, followed by notable narrowing thereafter. Increased IAP also intensifies TBI-associated increases in spatial QRS-T angle and QTc interval.
创伤性脑损伤（TBI）会影响心脏电功能，包括腹腔内压力（IAP）在内的几种脑外因素可能会进一步调节这种脑-心相互作用。本研究的目的是通过向量心电图（VCG）变量来研究TBI以及TBI期间IAP升高对心脏电功能的影响。
对连续的成年患者进行研究，这些患者要么是单纯性创伤性脑损伤（iTBI），要么是伴有腹部和/或四肢多发伤的创伤性脑损伤（pTBI）。记录患者的生存率、IAP以及VCG变量的变化，包括空间QRS-T角和QTc间期。所有患者在入住重症监护病房（ICU）后即刻（基线）以及入住后24、48、72和96小时进行观察。
共研究了74例年龄为45±18岁的患者。44例接受iTBI治疗，30例接受pTBI治疗。在所有患者中，TBI后空间QRS-T角和QTc间期均增加（p<0.001），pTBI患者增加得相对更多。与幸存者相比，非幸存者最终的空间QRS-T角增宽也更大（p<0.001），最明显的是在枕骨大孔疝形成前。IAP>12 mmHg的患者以及右侧半球损伤与左侧半球损伤的患者也出现了更宽的空间QRS-T角和更长的QTc间期（p<0.001）。TBI后24小时和48小时，I、II、III、aVR、aVF、V1、V2、V3和V6导联J点处的ST段水平下降，V1导联升高，尤其是在非幸存者中。
TBI后空间QRS-T角和QTc间期增加。如果枕骨大孔疝使TBI复杂化，空间QRS-T角通常会先进一步增宽，随后显著变窄。IAP升高也会加剧TBI相关的空间QRS-T角和QTc间期增加。
