Department of Anaesthesiology and Intensive Care, Medical University of Lublin, 20-954 Lublin, Poland.
Department of Anaesthesia and Intensive Care, Policlinico San Martino, 1100 Genova, Italy.
Int J Environ Res Public Health. 2020 Nov 21;17(22):8653. doi: 10.3390/ijerph17228653.
Traumatic brain injury (TBI) is commonly associated with cardiac dysfunction, which may be reflected by abnormal electrocardiograms (ECG) and/or contractility. TBI-related cardiac disorders depend on the type of cerebral injury, the region of brain damage and the severity of the intracranial hypertension. Decompressive craniectomy (DC) is commonly used to reduce intra-cranial hypertension (ICH). Although DC decreases ICH rapidly, its effect on ECG has not been systematically studied. The aim of this study was to analyze the changes in ECG in patients undergoing DC.
Adult patients without previously known cardiac diseases treated for isolated TBI with DC were studied. ECG variables, such as: spatial QRS-T angle (spQRS-T), corrected QT interval (QTc), QRS and T axes (QRS and T, respectively), STJ segment and the index of cardio-electrophysiological balance (iCEB) were analyzed before DC and at 12-24 h after DC. Changes in ECG were analyzed according to the occurrence of cardiac arrhythmias and 28-day mortality.
48 patients (17 female and 31 male) aged 18-64 were studied. Intra-cranial pressure correlated with QTc before DC ( < 0.01, = 0.49). DC reduced spQRS-T ( < 0.001) and QTc interval ( < 0.01), increased Tax ( < 0.01) and changed STJ in a majority of leads but did not affect QRS and iCEB. The iCEB was relatively increased before DC in patients who eventually experienced cardiac arrhythmias after DC ( < 0.05). Higher post-DC iCEB was also noted in non-survivors ( < 0.05), although iCEB values were notably heart rate-dependent.
ICP positively correlates with QTc interval in patients with isolated TBI, and DC for relief of ICH reduces QTc and spQRS-T. However, DC might also increase risk for life-threatening cardiac arrhythmias, especially in ICH patients with notably prolonged QTc before and increased iCEB after DC.
创伤性脑损伤（TBI）通常与心功能障碍相关，这可能反映在异常心电图（ECG）和/或收缩性上。TBI 相关的心脏疾病取决于脑损伤的类型、脑损伤区域和颅内压升高的严重程度。去骨瓣减压术（DC）常用于降低颅内压（ICH）。尽管 DC 能迅速降低 ICH，但它对 ECG 的影响尚未得到系统研究。本研究旨在分析接受 DC 的患者 ECG 的变化。
研究了接受 DC 治疗的、无先前已知心脏疾病的单纯 TBI 成年患者。分析了 ECG 变量，如：空间 QRS-T 角（spQRS-T）、校正 QT 间期（QTc）、QRS 和 T 轴（分别为 QRS 和 T）、STJ 段和心脏电生理平衡指数（iCEB），在 DC 前和 DC 后 12-24 小时进行分析。根据心律失常的发生和 28 天死亡率分析 ECG 的变化。
共研究了 48 例（17 例女性和 31 例男性）年龄 18-64 岁的患者。颅内压与 DC 前的 QTc 相关（<0.01，=0.49）。DC 降低了 spQRS-T（<0.001）和 QTc 间期（<0.01），增加了 Tax（<0.01），并改变了大多数导联的 STJ，但不影响 QRS 和 iCEB。在最终经历 DC 后心律失常的患者中，DC 前的 iCEB 相对升高（<0.05）。在非幸存者中也观察到更高的 DC 后 iCEB（<0.05），尽管 iCEB 值明显受心率影响。
在单纯 TBI 患者中，ICP 与 QTc 间期呈正相关，而缓解 ICH 的 DC 降低 QTc 和 spQRS-T。然而，DC 也可能增加危及生命的心律失常的风险，尤其是在 DC 前 QTc 明显延长和 iCEB 增加的 ICH 患者中。
