Department of Neurological Diseases, Privolzhsky Research Medical University, Nizhny Novgorod, Russia.
Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
Adv Exp Med Biol. 2023;1425:629-634. doi: 10.1007/978-3-031-31986-0_61.
The influence of cerebral edema and resultant secondary complications on the clinical outcome of traumatic brain injury (TBI) is well known. Clinical studies of brain water homeostasis dynamics in TBI are limited, which determines the relevance of our work. The purpose is to study changes in brain water homeostasis after TBI of varying severity compared to corresponding cerebral microcirculation parameters.
This non-randomized retrospective single-center study complies with the Helsinki Declaration for patient's studies. The study included 128 patients with posttraumatic ischemia (PCI) after moderate-to-severe TBI in the middle cerebral artery territory who were admitted to the hospital between July 2015 and February 2022. PCI was evaluated by perfusion computed tomography (CT), and brain edema was determined using net water uptake (NWU) on baseline CT images. The patients were allocated according to Marshall's classification. Multivariate linear regression models were performed to analyze data.
NWU in PCI areas were significantly higher than in patients with its absence (8.1% vs. 4.2%, accordingly; p < 0.001). In the multivariable regression analysis, the mean transit time increase was significantly and independently associated with higher NWU (R = 0.089, p < 0.01). In the PCI zone, cerebral blood flow, cerebral blood volume, and time to peak were not significantly associated with NWU values (p > 0.05). No significant differences were observed between the NWU values in PCI foci in different Marshall groups (p = 0.308).
Marshall's classification does not predict the progression of posttraumatic ischemia. The blood passage delays through the cerebral microvascular bed is associated with brain tissue water content increase in the PCI focus.
脑水肿及其继发并发症对创伤性脑损伤（TBI）临床结果的影响是众所周知的。TBI 中脑水动态平衡的临床研究是有限的，这决定了我们工作的相关性。目的是研究与相应的脑微循环参数相比，不同严重程度的 TBI 后脑水动态平衡的变化。
这项非随机回顾性单中心研究符合赫尔辛基宣言中对患者研究的规定。该研究纳入了 2015 年 7 月至 2022 年 2 月期间因中等至重度大脑中动脉区 TBI 导致的创伤后缺血（PCI）而住院的 128 名患者。通过灌注计算机断层扫描（CT）评估 PCI，并用基线 CT 图像上的净水分摄取（NWU）确定脑水肿。根据 Marshall 分类对患者进行分组。采用多元线性回归模型进行数据分析。
PCI 区的 NWU 明显高于无 PCI 区（8.1% vs. 4.2%，p<0.001）。在多变量回归分析中，平均通过时间的增加与更高的 NWU 显著且独立相关（R=0.089，p<0.01）。在 PCI 区，脑血流量、脑血容量和达峰时间与 NWU 值无显著相关性（p>0.05）。不同 Marshall 组的 PCI 灶的 NWU 值之间无显著差异（p=0.308）。
Marshall 分类不能预测创伤后缺血的进展。脑微血管床的血液通过时间延迟与 PCI 焦点中的脑组织含水量增加有关。
