Praveen Ranganatha, Jayant Aveek, Mahajan Shalvi, Jangra Kiran, Panda Nidhi Bidyut, Grover Vinod K, Tewari Manoj K, Bhagat Hemant
Department of Anesthesiology, Division of Neuroanaesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Department of Anesthesiology and Critical Care Medicine, Amrita Institute for Medical Sciences, Cochin, Kerala, India.
Surg Neurol Int. 2021 Apr 19;12:174. doi: 10.25259/SNI_5_2021. eCollection 2021.
Traumatic brain injury (TBI) is an acutely stressful condition. Stress and conglomeration of various factors predispose to the involvement of other organ systems. The stress response from TBI has been associated with cardiovascular complications reflecting as repolarization abnormalities on electrocardiogram (ECG) to systolic dysfunction on echocardiography. However, the perioperative cardiac functions in patients with TBI have not been evaluated.
We conducted a prospective observational study in 60 consecutive adult patients of either sex between the age of 10 and 70 years with an isolated head injury who were taken up for decompressive craniectomy as per institutional protocol. ECG and transthoracic echocardiography was carried out preoperatively and then postoperatively within 24-48 h.
The mean age of our study population was 39 + 13 years with a median Glasgow coma score of 11. A majority (73%) of our patients suffered moderate TBI. Preoperatively, ECG changes were seen in 48.33% of patients. Postoperatively, ECG changes declined and were seen only in 13.33% of the total patients. Similarly, echocardiography demonstrated preoperative systolic dysfunction in 13.33% of the total study population. Later, it was found that systolic function significantly improved in all the patients after surgery.
Cardiac dysfunction occurs frequently following TBI. Even patients with mild TBI had preoperative systolic dysfunction on echocardiography. Surgical intervention in the form of hematoma evacuation and decompression was associated with significant regression of both ECG and echocardiographic changes.
创伤性脑损伤（TBI）是一种急性应激状态。应激以及各种因素的聚集易导致其他器官系统受累。TBI的应激反应与心血管并发症相关，表现为心电图（ECG）复极异常至超声心动图显示的收缩功能障碍。然而，TBI患者围手术期的心脏功能尚未得到评估。
我们对60例年龄在10至70岁之间、因单纯头部损伤而按照机构方案接受减压颅骨切除术的成年患者进行了一项前瞻性观察研究，患者性别不限。术前及术后24 - 48小时内进行心电图和经胸超声心动图检查。
我们研究人群的平均年龄为39 ± 13岁，格拉斯哥昏迷评分中位数为11分。大多数（73%）患者为中度TBI。术前，48.33%的患者出现心电图改变。术后，心电图改变有所下降，仅13.33%的患者出现。同样，超声心动图显示术前13.33%的研究人群存在收缩功能障碍。后来发现，术后所有患者的收缩功能均显著改善。
TBI后心脏功能障碍频繁发生。即使是轻度TBI患者在超声心动图检查中也存在术前收缩功能障碍。以血肿清除和减压形式进行的手术干预与心电图和超声心动图改变的显著消退相关。
