严重脑外伤患者院内转运期间二次缺血发生率、颅内压和脑血管反应性动态比较。

Comparison of Secondary Ischaemia Incidence, Intracranial Pressure, and Cerebrovascular Reactivity Dynamics During Intrahospital Transportation of Severe TBI Patients.

机构信息

Department of Neurological Diseases, Privolzhsky Research Medical University, Nizhny Novgorod, Russia.

Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM, USA.

出版信息

Adv Exp Med Biol. 2024;1463:61-65. doi: 10.1007/978-3-031-67458-7_11.

DOI:10.1007/978-3-031-67458-7_11

PMID:39400801

Abstract

UNLABELLED

The aims of the study were to evaluate posttraumatic cerebral ischaemia (PTCI) incidence in severe traumatic brain injury (TBI) patients and to assess the intracranial pressure (ICP) and cerebrovascular reactivity dynamics during intrahospital transportation (IT).

MATERIALS

A total of 153 severe TBI patients and 182 IT were included. The mean Glasgow Coma Scale (GCS) score was 6.7 ± 2.1. ICP and arterial pressure were invasively monitored, and an improved pressure reactivity index (iPRx) was calculated from the measured parameters. Statistical analysis was done using Student's t-criterion and Wilcoxon criterion where appropriate.

RESULTS

Perfusion computed tomography (PCT) revealed a neuroimaging PTCI pattern in all 153 severe TBI patients (100%). In 58 patients (37.9%), ischaemia extended to both hemispheres; in 95 patients (62.1%), it affected only one hemisphere. The mean ICP during IT was significantly higher (26.1 ± 13.5 mm Hg, p < 0.001) than before the IT (19.9 ± 5.3 mm Hg). All patients had increased ICP, especially during vertical movement in an elevator (maximum 75.2 mm Hg).

CONCLUSION

PTCI was detected in all severe TBI patients in coma. The IT of comatose severe TBI patients leads to a significant increase in ICP and iPRx.

摘要

目的

评估严重创伤性脑损伤（TBI）患者创伤后脑缺血（PTCI）的发生率，并评估院内转运（IT）期间的颅内压（ICP）和脑血管反应性动态。

材料

共纳入 153 例严重 TBI 患者和 182 次 IT。格拉斯哥昏迷量表（GCS）评分为 6.7±2.1。ICP 和动脉压均行有创监测，并从测量参数中计算出改良压力反应性指数（iPRx）。适当情况下采用 Student's t 检验和 Wilcoxon 检验进行统计学分析。

结果

灌注计算机断层扫描（PCT）显示 153 例严重 TBI 患者均存在神经影像学 PTCI 模式（100%）。58 例（37.9%）患者缺血累及双侧半球，95 例（62.1%）患者仅累及一侧半球。IT 期间的平均 ICP 明显升高（26.1±13.5 mm Hg，p<0.001），高于 IT 前（19.9±5.3 mm Hg）。所有患者的 ICP 均升高，尤其是在电梯内垂直移动时（最高达 75.2 mm Hg）。