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干扰系数在脑出血患者脑水肿监测与治疗中的作用

Role of disturbance coefficient in monitoring and treatment of cerebral edema in patients with cerebral hemorrhage.

作者信息

Gao Wen-Wen, Jiang Xiao-Bing, Chen Peng, Zhang Liang, Yang Lei, Yuan Zhi-Hai, Wei Yao, Li Xiao-Qiang, Tang Xiao-Lu, Wang Feng-Lu, Wu Hao, Zhao Hai-Kang

机构信息

Department of Neurosurgery, The Second Affiliated Hospital of Xi'an Medical University, Xi'an 710038, Shaanxi Province, China.

Department of Neurosurgery, Xi'an Medical University, Xi'an 710021, Shaanxi Province, China.

出版信息

World J Clin Cases. 2025 May 16;13(14):102534. doi: 10.12998/wjcc.v13.i14.102534.

Abstract

BACKGROUND

At present, the conventional methods for diagnosing cerebral edema in clinical practice are computed tomography (CT) and magnetic resonance imaging (MRI), which can evaluate the location and degree of peripheral cerebral edema, but cannot realize quantification. When patients have symptoms of diffuse cerebral edema or high cranial pressure, CT or MRI often suggests that cerebral edema is lagging and cannot be dynamically monitored in real time. Intracranial pressure monitoring is the gold standard, but it is an invasive operation with high cost and complications. For clinical purposes, the ideal cerebral edema monitoring should be non-invasive, real-time, bedside, and continuous dynamic monitoring. The disturbance coefficient (DC) was used in this study to dynamically monitor the occurrence, development, and evolution of cerebral edema in patients with cerebral hemorrhage in real time, and review head CT or MRI to evaluate the development of the disease and guide further treatment, so as to improve the prognosis of patients with cerebral hemorrhage.

AIM

To offer a promising new approach for non-invasive adjuvant therapy in cerebral edema treatment.

METHODS

A total of 160 patients with hypertensive cerebral hemorrhage admitted to the Department of Neurosurgery, Second Affiliated Hospital of Xi'an Medical University from September 2018 to September 2019 were recruited. The patients were randomly divided into a control group ( = 80) and an experimental group ( = 80). Patients in the control group received conventional empirical treatment, while those in the experimental group were treated with mannitol dehydration under the guidance of DC. Subsequently, we compared the two groups with regards to the total dosage of mannitol, the total course of treatment, the incidence of complications, and prognosis.

RESULTS

The mean daily consumption of mannitol, the total course of treatment, and the mean hospitalization days were 362.7 ± 117.7 mL, 14.8 ± 5.2 days, and 29.4 ± 7.9 in the control group and 283.1 ± 93.6 mL, 11.8 ± 4.2 days, and 23.9 ± 8.3 in the experimental group ( < 0.05). In the control group, there were 20 patients with pulmonary infection (25%), 30 with electrolyte disturbance (37.5%), 20 with renal impairment (25%), and 16 with stress ulcer (20%). In the experimental group, pulmonary infection occurred in 18 patients (22.5%), electrolyte disturbance in 6 (7.5%), renal impairment in 2 (2.5%), and stress ulcers in 15 (18.8%) ( < 0.05). According to the Glasgow coma scale score 6 months after discharge, the prognosis of the control group was good in 20 patients (25%), fair in 26 (32.5%), and poor in 34 (42.5%); the prognosis of the experimental group was good in 32 (40%), fair in 36 (45%), and poor in 12 (15%) ( < 0.05).

CONCLUSION

Using DC for non-invasive dynamic monitoring of cerebral edema demonstrates considerable clinical potential. It reduces mannitol dosage, treatment duration, complication rates, and hospital stays, ultimately lowering hospitalization costs. Additionally, it improves overall patient prognosis, offering a promising new approach for non-invasive adjuvant therapy in cerebral edema treatment.

摘要

背景

目前,临床实践中诊断脑水肿的传统方法是计算机断层扫描(CT)和磁共振成像(MRI),它们可以评估外周脑水肿的位置和程度,但无法实现量化。当患者出现弥漫性脑水肿或高颅压症状时,CT或MRI往往提示脑水肿滞后,且无法实时动态监测。颅内压监测是金标准,但它是一种侵入性操作,成本高且有并发症。对于临床而言,理想的脑水肿监测应是非侵入性、实时、床边和连续动态监测。本研究采用干扰系数(DC)实时动态监测脑出血患者脑水肿的发生、发展及演变情况,并复查头颅CT或MRI以评估病情发展并指导进一步治疗,从而改善脑出血患者的预后。

目的

为脑水肿治疗提供一种有前景的非侵入性辅助治疗新方法。

方法

选取2018年9月至2019年9月在西安医学院第二附属医院神经外科住院的160例高血压脑出血患者。将患者随机分为对照组(n = 80)和实验组(n = 80)。对照组患者接受常规经验性治疗,实验组患者在DC指导下使用甘露醇脱水治疗。随后,比较两组患者甘露醇总用量、总疗程、并发症发生率及预后情况。

结果

对照组甘露醇日均用量、总疗程及平均住院天数分别为362.7±117.7 mL、14.8±5.2天和29.4±7.9天,实验组分别为283.1±93.6 mL、11.8±4.2天和23.9±8.3天(P<0.05)。对照组发生肺部感染20例(25%)、电解质紊乱30例(37.5%)、肾功能损害20例(25%)、应激性溃疡16例(20%)。实验组发生肺部感染18例(22.5%)、电解质紊乱6例(7.5%)、肾功能损害2例(2.5%)、应激性溃疡15例(18.8%)(P<0.05)。出院6个月后根据格拉斯哥昏迷量表评分,对照组预后良好20例(25%)、中等26例(32.5%)、差34例(42.5%);实验组预后良好32例(40%)、中等36例(45%)、差12例(15%)(P<0.05)。

结论

使用DC对脑水肿进行非侵入性动态监测具有较大临床潜力。它可减少甘露醇用量、治疗时长、并发症发生率及住院时间,最终降低住院费用。此外,它还能改善患者总体预后,为脑水肿治疗提供了一种有前景的非侵入性辅助治疗新方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4804/11752430/954f857ee5c0/102534-g001.jpg

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