与早期脑死亡相关的临床-放射学因素。

Clinico-radiological related to early brain death factors.

机构信息

Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain.

出版信息

Med Intensiva (Engl Ed). 2022 Jan;46(1):1-7. doi: 10.1016/j.medine.2021.11.005. Epub 2021 Nov 19.

DOI:10.1016/j.medine.2021.11.005

PMID:34802992

Abstract

OBJECTIVE

To identify clinical and radiological factors associated to early evolution to brain death (BD), defined as occurring within the first 24 h.

DESIGN

A retrospective cohort study was made covering the period 2015-2017.

SETTING

An adult Intensive Care Unit (ICU).

PATIENTS/METHODS: Epidemiological, clinical and imaging (CT scan) parameters upon admission to the ICU in patients evolving to BD.

RESULTS

A total of 166 patients with BD (86 males, mean age 62.7 years) were analyzed. Primary cause: intracerebral hemorrhage 42.8%, subarachnoid hemorrhage 18.7%, traumatic brain injury 17.5%, anoxia 9%, stroke 7.8%, other causes 4.2%. Epidemiological data: arterial hypertension 50%, dyslipidemia 34%, smoking 33%, antiplatelet medication 21%, alcoholism 19%, anticoagulant therapy 15%, diabetes 15%. The Glasgow Coma Score (GCS) upon admission was 3 in 68.8% of the cases in early BD versus in 38.2% of the cases in BD occurring after 24 h (p = 0.0001). Eighty-five patients presented supratentorial hematomas with a volume of 90.9 ml in early BD versus 82.7 ml in BD > 24 h (p = 0.54). The mean midline shift was 10.7 mm in early BD versus 7.8 mm in BD > 24 h (p = 0.045). Ninety-one patients presented ventriculomegaly and 38 additionally ependymal transudation (p = 0.021). Thirty-six patients with early BD versus 24 with BD > 24 h presented complete effacement of basal cisterns (p = 0.005), sulcular effacement (p = 0.013), loss of cortico-subcortical differentiation (p = 0.0001) and effacement of the suprasellar cistern (p = 0.005). The optic nerve sheath measurements showed no significant differences between groups.

CONCLUSIONS

Early BD (>24 h) was associated to GCS < 5, midline shift, effacement of the basal cisterns, cerebral sulci and suprasellar cistern, and ependymal transudation.

摘要

目的

确定与脑死亡（BD）早期演变相关的临床和影像学因素，BD 定义为发生在 24 小时内。

设计

回顾性队列研究，涵盖 2015-2017 年期间。

地点

成人重症监护病房（ICU）。

患者/方法：对 ICU 中进展为 BD 的患者的入院时的流行病学、临床和影像学（CT 扫描）参数进行分析。

结果

共分析了 166 例 BD 患者（男性 86 例，平均年龄 62.7 岁）。主要病因：脑出血 42.8%，蛛网膜下腔出血 18.7%，创伤性脑损伤 17.5%，缺氧 9%，中风 7.8%，其他原因 4.2%。流行病学数据：动脉高血压 50%，血脂异常 34%，吸烟 33%，抗血小板药物治疗 21%，酒精中毒 19%，抗凝治疗 15%，糖尿病 15%。早期 BD 中 68.8%的病例入院时格拉斯哥昏迷评分（GCS）为 3，而 24 小时后 BD 中的病例为 38.2%（p=0.0001）。早期 BD 中有 85 例患者出现幕上血肿，体积为 90.9ml，而 24 小时后 BD 中有 82.7ml（p=0.54）。中线移位的平均值为早期 BD 中 10.7mm，24 小时后 BD 中 7.8mm（p=0.045）。91 例患者出现脑室扩大，38 例患者出现室管膜渗出（p=0.021）。36 例早期 BD 患者与 24 例 24 小时后 BD 患者相比，基底池完全消失（p=0.005）、脑沟消失（p=0.013）、皮质下分化丧失（p=0.0001）和鞍上池消失（p=0.005）。视神经鞘测量在两组之间无显著差异。