Forcione Mario, Yakoub Kamal Makram, Chiarelli Antonio Maria, Perpetuini David, Merla Arcangelo, Sun Rosa, Sawosz Piotr, Belli Antonio, Davies David James
University Hospitals Birmingham NHS Foundation Trust, National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR-SRMRC), Mindelsohn Way, Birmingham, UK.
University of Birmingham, Neuroscience & Ophthalmology Research Group, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, Edgbaston, Birmingham, UK.
Quant Imaging Med Surg. 2020 Nov;10(11):2085-2097. doi: 10.21037/qims-20-742.
The care given to moderate and severe traumatic brain injury (TBI) patients may be hampered by the inability to tailor their treatments according to their neurological status. Contrast-enhanced near-infrared spectroscopy (NIRS) with indocyanine green (ICG) could be a suitable neuromonitoring tool.
Monitoring the effective attenuation coefficients (EAC), we compared the ICG kinetics between five TBI and five extracranial trauma patients, following a venous-injection of 5 mL of 1 mg/mL ICG, using two commercially available NIRS devices.
A significantly slower passage of the dye through the brain of the TBI group was observed in two parameters related to the first ICG inflow into the brain (P=0.04; P=0.01). This is likely related to the reduction of cerebral perfusion following TBI. Significant changes in ICG optical properties minutes after injection (P=0.04) were registered. The acquisition of valid optical data in a clinical environment was challenging.
Future research should analyze abnormalities in the ICG kinetic following brain trauma, test how these values can enhance care in TBI, and adapt the current optical devices to clinical settings. Also, studies on the pattern in changes of ICG optical properties after venous injection can improve the accuracy of the values detected.
由于无法根据中度和重度创伤性脑损伤（TBI）患者的神经状态调整治疗方案，对这些患者的护理可能会受到阻碍。使用吲哚菁绿（ICG）的对比增强近红外光谱（NIRS）可能是一种合适的神经监测工具。
在静脉注射5毫升1毫克/毫升的ICG后，我们使用两种市售的NIRS设备，通过监测有效衰减系数（EAC），比较了5名TBI患者和5名颅外创伤患者的ICG动力学。
在与ICG首次流入大脑相关的两个参数中，观察到TBI组中染料在大脑中的通过速度明显较慢（P = 0.04；P = 0.01）。这可能与TBI后脑灌注减少有关。注射后数分钟ICG光学特性发生了显著变化（P = 0.04）。在临床环境中获取有效的光学数据具有挑战性。
未来的研究应分析脑外伤后ICG动力学的异常情况，测试这些值如何改善TBI的护理，并使当前的光学设备适应临床环境。此外，对静脉注射后ICG光学特性变化模式的研究可以提高检测值的准确性。
