Early changes of arginine vasopressin and angiotensin II in patients with acute cerebral injury

ＡＤｅｐａｒｔｍｅｎｔｏｆＥｍｅｒｇｅｎｃｙ ,ＳｉｒＲｕｎＲｕｎＳｈａｗＨｏｓｐｉｔａｌ,ＭｅｄｉｃａｌＣｏｌｌｅｇｅ ,ＺｈｅｊｉａｎｇＵｎｉｖｅｒｓｉｔｙ ,Ｈａｎｇｚｈｏｕ 310 0 16 ,Ｃｈｉｎａ(ＨｕａｎｇＷＤ ,ＷｕＳＤ ,ＪｉｎＺＦａｎｄＢａｏＤＧ)ＤｅｐａｒｔｍｅｎｔｏｆＥｍｅｒｇｅｎｃｙ ,ＦｉｒｓｔＡｆｆｌｉａｔｅｄＨｏｓｐｉｔａｌ,ＭｅｄｉｃａｌＣｏｌｌｅｇｅ ,ＺｈｅｊｉａｎｇＵｎｉｖｅｒｓｉｔｙ ,Ｈａｎｇｚｈｏｕ 310 0 0 3 ,Ｃｈｉｎａ(ＹａｎｇＹＭ)ＤｅｐａｒｔｍｅｎｔｏｆＮｅｕｒｏｓｕｒｇ…     

小剂量精氨酸加压素在血管扩张性休克病人中的应用

目的观察小剂量精氨酸加压素(arginine vasopressin,AVP)在血管扩张性休克病人治疗中的作用及其并发症。方法对17例血管扩张性休克病人进行了研究。病人均予儿茶酚胺类药物治疗,在充分容量治疗后加用小剂量AVP(<0.04U/min),在维持MAP≥65mmHg的基础上逐步调整儿茶酚胺类药物的剂量。记录AVP治疗前后的血流动力学参数、肾功能、儿茶酚胺类药物的用量、并发症及病人的预后。结果予小剂量AVP治疗后,病人HR和儿茶酚胺类药物的剂量均显著下降(P<0.01),MAP显著升高(P<0.05),心脏指数(CI)显著下降(P<0.01),每搏量指数(SVI)和周身血管阻力指数(SVRI)均显著升高(P<0.05),尿量显著增加(P<0.01),血肌酐(Cr)显著下降(P<0.01),肌酐清除率(CL)显著升高(P<0.01)。结论加用小剂量AVP治疗可明显改善血管扩张性休克病人的血流动力学,可减少儿茶酚胺类药物的需要量,并改善肾功能。     

Early change of plasma and cerebrospinal fluid arginine vasopressin in traumatic subarachnoid hemorrhage

Objective： To investigate the changes and effects of arginine vasopressin （AVP） in patients with acute traumatic subarachnoid hemorrhage （tSAH）. Methods： The plasma and cerebrospinal fluid （CSF） level of AVP, and intracranial pressure （ICP） were measured in a total of 21 patients within 24 hours after tSAH. The neurological status of the patients was evaluated by Glasgow Coma Scale （GCS）. Correlation between AVP and ICP, GCS was analyzed respectively. Meanwhile, 18 healthy volunteers were recruited as control group. Results： Compared with control group, the levels （pg/ml） of AVP in plasma and CSF （x±s） in tSAH group were significantly increased within 24 hours （38.72±24.71 vs 4.54±1.38 and 34.61±21.43 vs 4.13± 1.26, P〈0.01）, and was remarkably higher in GCS ≤8 group than GCS〉8 group （50.96±36.81 vs 25.26±12.87 and 44.68±31.72 vs 23.53±10.94, P〈0.05）. The CSF AVP level was correlated with ICP （r= 0.46, P〈0.05）, but no statistically significant correlation was found between plasma AVP, CSF AVP and initial GCS （r= -0.29, P〉0.05 and r= -0.32, P〉0.05, respectively）. The ICP （ram Hg） in tSAH patients was elevated and higher in GCS ≤ 8 group than in GCS〉8 group （25.9±9.7 vs 17.6±5.2, P〈0.05）. Conclusion： Our research suggests that AVP is correlated with the severity oftSAH, and may be involved in the pathophysiological process of brain damage in the early stage after tSAH. It seems that compared with the plasma AVP concentration, CSF AVP is more related to the severity oftSAH.     

精氨酸血管加压素系统在吸入麻醉中的研究进展

精氨酸血管加压素(AVP)由下丘脑大细胞性神经分泌细胞分泌.除了进入外周血液循环维持机体稳态外,AVP还作为直接的神经递质参与多种脑功能的调节.近来研究表明,AVP系统在吸入麻醉中发挥重要作用.全文从镇静催眠、镇痛、肌松、控制应激等全身麻醉四要素的角度综述该系统在吸入麻醉中的作用,以期为阐明吸入麻醉机制提供新的视角.     

Changes of dipalmitoyl phosphatidyl choline after mechanical ventilation in patients with acute cerebral injury

Objective: To detect the levels of dipalmitoyl phosphatidyl choline (DPPC) in the sputum of the patients with acute cerebral injury without primary pulmonary injury after mechanical ventilation treatment. Methods: DPPC levels in sputum of 35 patients with acute cerebral injury but without pulmonary injury were detected with high performance liquid chromatography at the beginning of ventilation and 16-20 days, 21-40 days, and 41-60 days after ventilation, respectively. Results: There was no significant difference of the DPPC levels between 16-20 days after ventilation (3.36±0.49) and at the beginning of ventilation (3.37±0.58) (P>0.05). The mean levels of DPPC decreased significantly at 21-40 days (2.87 mg/ml±0.26 mg/ml, P < 0.05) and 41-60 days (1.93 mg/ml±0.21 mg/ml, P < 0.01) after ventilation compared with that at the beginning of ventilation. At the same period, the peak inspiratory pressure and the mean pressure of airway increased significantly, whereas the static compliance and the partial pressure of oxygen in artery decreased significantly. Among the 25 patients who received ventilation for more than 20 days, 8 (32%) had slightly-decreased partial pressure of oxygen in artery compared with that at the beginning of ventilation. Conclusions: Mechanical ventilation can decrease the DPPC levels, decrease the lung compliance and increase the airway pressure, even impair the oxygenation function in patients with acute cerebral injury. Abnormal DPPC is one of the major causes of ventilator-associated lung injury.     

Outcome of 2 284 cases with acute traumatic brain injury

ＴＤｅｐａｒｔｍｅｎｔｏｆＮｅｕｒｏｓｕｒｇｅｒｙ ,ＲｏｎｇｇａｎｇＨｏｓｐｉｔａｌ ,Ｓｈｅｎｚｈｅｎ5 18116 ,Ｃｈｉｎａ (ＺｈａｎｇＪａｎｄＺｈｏｎｇＴＡ)ＤｅｐａｒｔｍｅｎｔｏｆＮｅｕｒｏｓｕｒｇｅｒｙ ,ＣｈａｎｇｚｈｅｎｇＨｏｓｐｉｔａｌ,ＳｈａｎｇｈａｉＮｅｕｒｏｓｕｒｇｅｒｙＩｎｓｔｉｔｕｔｅ ,Ｓｈａｎｇｈａｉ 2 0 0 0 0 3 ,Ｃｈｉｎａ(ＪｉａｎｇＪＹ ,ＹｕＭＫａｎｄＺｈｕＣ)ｒａｕｍａｔｉｃｂｒａｉｎｉｎｊｕｒｙ (ＴＢＩ) ,ａｃｏｍｍｏｎｃｌｉｎｉｃａｌｐｒｏｂｌｅｍｆｏｒｎｅｕｒｏｓｕｒｇ…     

Significance of serum neuron-specific enolase in patients with acute traumatic brain injury

OBJECTIVE: To study the association between serum neuron-specific enolase (NSE) and the extent of brain damage and the outcome after acute traumatic brain injury (TBI). METHODS: The release patterns of serum NSE in 78 patients after acute TBI were analyzed by using the enzyme linked immunosorbent assay. The levels of NSE were compared with Glasgow coma scale, the category of brain injury and the outcome after 6 months of injury. RESULTS: There were different NSE values in patients with minor (12.96 microg/L+/-2.39 microg/L), moderate (23.44 microg/L+/-5.33 microg/L) and severe brain injury (42.68 microg/L+/-4.57 microg/L). After severe TBI, the concentration of NSE in patients with epidural hematomas was 13.38 microg/L+/-4.01 microg/L, 24.03 microg/L+/-2.85 microg/L in brain contusion without surgical intervention group, 55.20 microg/L+/-6.35 microg/L in brain contusion with surgical intervention group, and 83.85 microg/L+/-15.82 microg/L in diffuse brain swelling group. There were close correlations between NSE values and Glasgow coma scale (r=-0.608, P<0.01) and the extent of brain injury (r=0.75, P<0.01). Patients with poor outcome had significantly higher initial and peak NSE values than those with good outcome (66.40 microg/L+/-9.46 microg/L, 94.24 microg/L+/-13.75 microg/L vs 32.16 microg/L+/-4.21 microg/L, 34.08 microg/L+/-4.40 microg/L, P<0.01, respectively). Initial NSE values were negatively related to the outcome (r=-0.501, P<0.01). Most patients with poor outcomes had persisting or secondary elevated NSE values. CONCLUSIONS: Serum NSE is one of the valuable neurobiochemical markers for assessment of the severity of brain injury and outcome prediction.     

Comparing the effect of arginine vasopressin on ear and finger photoplethysmography

STUDY OBJECTIVE: To test whether the relative insensitivity of craniofacial vessels to catecholamines differs in response to arginine vasopressin. DESIGN: Prospective, observational human study. SETTING: University hospital. PATIENTS: 8 ASA physical status I and II women scheduled for elective myomectomy. INTERVENTIONS: Patients underwent elective myomectomy surgery with intrauterine injection of arginine vasopressin. MEASUREMENTS: Finger, ear, and forehead photoplethysmographs were monitored. Changes in the plethysmographic amplitudes were recorded before and after arginine vasopressin injection. MAIN RESULTS: In all subjects, ear photoplethysmographic amplitude (but not oxygen saturation) decreased precipitously (62% +/- 10%; P < 0.001) after arginine vasopressin injection. In contrast, there was no significant decline in the finger signal (4.5% +/- 27%; P = 0.19). The forehead plethysmograph decreased in amplitude, but this finding did not achieve significance (33% +/- 18%; P = 0.18). CONCLUSION: In contrast to prior observations during adrenergic activation, arginine vasopressin induced relatively greater vasoconstriction at the ear and forehead than at the finger. This finding has potential implications with respect to arginine vasopressin's effect on blood flow and indicates that monitoring the ear plethysmographic signal may provide useful information during arginine vasopressin administration.     

Early changes of arginine vasopressin and angiotensin Ⅱ in patients with acute cerebral injury

OBJECTIVE: To study the changes and clinical significance of arginine vasopressin (AVP) and angiotensin II (AT-II) in patients with acute moderate and severe cerebral injury. METHODS: The early plasma concentration was checked by radioimmunoassay in 47 cases of acute moderate and severe cerebral injury, 30 cases of non-cerebral injury and 30 healthy volunteers. RESULTS: The early plasma concentrations of AVP (50.23 ng/L +/- 15.31 ng/L) and AT-II (248.18 ng/L +/- 82.47 ng/L) in cerebral injury group were higher than those in non-cerebral injury group (AVP for 30.91 ng/L +/- 11.48 ng/L and AT-II for 120.67 ng/L +/- 42.49 ng/L, P<0.01). The early plasma concentrations of AVP and AT-II in cerebral injury group were also obviously higher than those of the volunteers (AVP for 5.16 ng/L +/- 4.23 ng/L and AT-II for 43.11 ng/L +/- 16.39 ng /L, P<0.001). At the same time, the early plasma level of AVP (58.90 ng/L +/- 18.12 ng/L) and AT-II (292.13 ng/L +/- 101.17 ng/ L) was higher in severe cerebral injured patients than moderate cerebral injured ones (AVP for 36.68 ng/L +/- 12.16 ng/L and AT-II for 201.42 ng/L +/- 66.10 ng/L, P<0.01). The early level of AVP and AT-II was negatively related to the GCS scales in acute cerebral injury. The early plasma concentrations of AVP (45.98 ng/L +/- 13.48 ng/L) and AT-II (263. 28 ng/L +/- 80.23 ng/L) were lower in epidural hematoma group than those of subdural hematoma and cerebral injury group (AVP for 64.12 ng/L +/- 15.56 ng /L and AT-II for 319.82 ng/L +/- 108.11 ng/L, P<0. 01). CONCLUSIONS: AVP and AT-II may play an important role in pathophysiologic process in the secondary cerebral injury. The more severe the cerebral injury is, the higher the early level of AVP and AT-II will be. The early plasma level of AVP and AT-II may be one of the severity indexes of cerebral injury.     

Early changes of endothelin,nitric oxide and arginine—vasopressin in patients with acute cerebral injury

OBJECTIVE: To investigate the early changes and clinical significance of plasma endothelin (ET), nitric oxide (NO) and arginine-vasopressin (AVP) in patients with acute moderate or severe cerebral injury. METHODS: The early (at 24 hours after injury) plasma concentrations of ET, NO and AVP were measured with radioimmunoassay and Green technique in 48 cases of acute moderate (GCS8 in 21 cases) cerebral injury (Group A), in 42 cases of non-cerebral injury (Group B) and in 38 normal individuals (Group C), respectively. RESULTS: The early plasma concentrations of ET (109.73 ng/L+/-12.61 ng/L), NO (92.82 micromol/L+/-18.21 micromol/L ) and AVP (49.78 ng/L+/-14.29 ng/L) in Group A were higher than those in Group B (67.90 ng/L+/-11.33 ng/L, 52.66 micromol/L+/-12.82 micromol/L and 29.93 ng/L+/-12.11 ng/L, respectively, P<0.01) and Group C (50.65 ng/L+/-17.12 ng/L, 36.12 micromol/L+/-2.16 micromol/L and 5.18 ng/L+/-4.18 ng/L, respectively, P<0.001 ). The amounts of ET, NO and AVP in patients with severe cerebral injury were 116.18 ng/L+/-18.12 ng/L, 108.19 micromol/L+/-13.28 micromol/L and 58.13 ng/L+/-16.78 ng/L, respectively, which were significantly higher than that of the patients with moderate cerebral injury (92.33 ng/L+/-16.32 ng/L, 76.38 micromol/L+/-12.71 micromol/L and 36.18 ng/L+/-12.13 ng/L respectively, P<0.01 ). The early levels of ET, NO and AVP in Group A were negatively related to the GCS scales. The amounts of ET, NO and AVP were 126.23 ng/L+/-15.23 ng/L, 118.18 micromol/L+/-10.12 micromol/L and 63.49 ng/L+/-14.36 ng/L respectively in patients with subdural hematoma, which were significantly higher than those in patients with epidural hematoma (81.13 ng/L+/-12.37 ng/L, 68.02 micromol/L+/-13.18 micromol/L and 45.63 ng/L+/-12.41 ng/L respectively, P<0.01). The plasma concentrations of ET, NO and AVP in stable duration (at 336 hours after injury) in Group A and Group B were similar to those in Group C. CONCLUSIONS: ET, NO and AVP were related to the pathophysiological process that occurs in the early stage of acute cerebral injury and the values of ET, NO and AVP correlate positively with the clinical manifestations. The changes of plasma ET, NO and AVP can be regarded as important indices to assess the severity of acute cerebral injury.     

The effect of arginine vasopressin on organ donor procurement and lung function

Background

Hormone replacement therapy (HRT) is becoming more common when managing brain-dead donors. Arginine vasopressin (AVP) is associated with benefits but is not consistently used. We hypothesize that AVP is associated with the maintenance of lung function and successful recovery in donors and enhanced lung graft performance in recipients.

Methods

The Organ Procurement and Transplantation Network database was used. Study donors were those treated with HRT and procured from January 1, 2009 to June 30, 2011. AVP (+) and AVP (−) donors were compared. Donor lung function, the rate of successful lung procurement, and the incidence of graft failure in recipients were studied.

Results

There were 12,322 donors included, of which 7686 received AVP (62.4%). Cerebrovascular accident (4722 [38.3%]) was the most common cause of donor death. There was a significant increase in high yield (≥4 organs) (51.0% versus 39.3%, <0.001), mean number of organs (3.75 versus 3.33, <0.001), and rate of successful lung recovery (26.3% versus 20.5%, <0.001) with AVP. Lung function was preserved to a greater degree in donors receiving AVP. Adjusting the significant factors, AVP was independently associated with lung procurement (1.220 [1.114–1.336], <0.001). The incidence of early graft failure was not changed.

Conclusions

AVP with HRT is associated with the maintenance of lung function and a significant increase in successful organ recovery in donors without untoward effects in the recipient. AVP should be universally adopted as a component of HRT in the management of donors with neurologic death.     

Evaluation of stress hormones in traumatic brain injury patients with gastrointestinal bleeding

Objective： To evaluate the local risk factors of traumatic brain injury （TBI） patients developing gastrointestinal （GI） bleeding during the early hospitalization in neurosurgery intensive care unit （NICU）. Method： From September 2005 to February 2006, 41 patients admitted to NICU and 13 healthy volunteers were involved in our study. Blood samples at 24 hours, 2-3 days and 5-7 days were obtained from each patient via arterial line at 8 a.m. to measure the concentrations of serum adrenocorticotropic hormone （ACTH）, total cortisol and gastrin. The collected serum was immersed in an ice bath and tested by the Immulite 1000 systems. Data were analyzed by SPSS 11.5. Results： Within 24 hours following TBI, the concentrations of total cortisol, ACTH and gastrin increased proportionally to the severity of injury, especially significant in the experimental group （P〈0.05）. The concentrations of ACTH and gastrin were higher in the GI bleeding positive group than in the GI bleeding negative group, （F=1.413, P=0.253） for ACTH and （F=9.371, P=0.006） for gastrin. GI bleeding had a positive correlation with gastrin concentration （r=0. 312, P〈0.05） and a negative correlation with serum hemoglobin （Hb） （r=-0.420, P〈0.01）. The clinical incidence of GI bleeding was 24.39% （10/41） in the experimental group. Within 24 hours, GI bleeding had a strong correlation with gastrin concentration （OR=26.643, P〈0.05） and hematocrit （Hct） （OR=5.385, P〈0.05）. High ACTH concentration （〉100 pg/ml） increased the frequency of GI bleeding. For patients with severe TBI and treated with routine antacids, the incidence of GI bleeding was 40.91% （9/22） and the mortality rate was 20%（2/10）. Conclusions： Low Glasgow coma scale scores, low Hb, high concentrations of gastrin and ACTH （〉 100 pg/ml） are risk factors and can be predictive values for post-traumatic GI bleeding. Severe TBI patients have high risks of GI bleeding with high mortality.     

Significance of serum neuron-specific enolase in patients with acute traumatic brain iniurv

Objective: To study the association between serum neuron-specific enolase ( NSE) and the extent of brain damage and the outcome after acute traumatic brain injury (TBI).Methods: The release patterns of serum NSE in 78 patients after acute TBI were analyzed by using the enzyme linked immunosobent assay. The levels of NSE were compared with Glasgow coma scale, the category of brain injury and the outcome after 6 months of injury.Results: There were different NSE values in patients with minor ( 12.96 μg/L ±2.39 μg/L ), moderate ( 23.44 μg/L ±5.33 μg/L ) and severe brain injury ( 42.68 μg/L ±4.57 μg/L ). After severe TBI, the concentration of NSE in patients with epidural hematomas was 13.38 μg/L±4.01 μg/L, 24.03 μg/L±2.85 μg/L in brain contusion without surgical intervention group, 55.20 μg/L ±6.35 μg/L in brain contusion with surgical intervention group, and 83.85 μg/L ± 15.82 μg/L in diffuse brain swelling group. There were close correlations between NSE values and Glasgow coma scale     

Changes in cerebral hemodynamics in patients with posttraumatic diffuse brain swelling after external intraventricular drainage

Purpose: To investigate the changes of cerebral hemodynamics pre- and post-ventricular drainage in patients with posttraumatic acute diffuse brain swelling. Methods: Twenty-four cases of traumatic diffuse brain swelling were analyzed retrospectively. Patients in nonsurgical group were treated by medicine therapy. Patients in surgical group were treated by external ventricular drainage plus medicine therapy. The first CT perfusion scan was completed within 4-5 h after trauma and scanned again after 7 days. The changes of perfusion parameters in area-ofinterest in two groups were analyzed and compared before and after treatment. Results: Compared with the nonsurgical group, the value of cerebral blood volume, cerebral blood flow and mean transit time in bilateral frontal temporoparietal grey matter, basal ganglia, cerebellum, and brain stem at pre- and post-therapy were increased significantly (p < 0.05) in surgical group, and consequently the prognosis of patients undergoing surgery was also better than that of nonsurgical group. Conclusion: External ventricular drainage can improve cerebral perfusion and increase survival quality for the patients with posttraumatic acute diffuse brain swelling.     

Role of bromocriptine in multi-spectral manifestations of traumatic brain injury

Purpose: Despite the prevalence and cost of traumatic brain injury related disabilities, there is paucity in the literature on modern approaches to pharmacotherapy. Medications may promote recovery by enhancing some neurological functions without impacting others. Herein we discussed the role ofbromocriptine in neurorehabilitation for patients with traumatic brain injury.Methods: A cohort comprising of 36 selective nonsurgical cases of traumatic brain injury in minimallyconscious state were enrolled in the study. After hemodynamic stability, bromocriptine was given atpaediatric dose of 3.75 mg/d and adult dose of 7.5 mg/d. It was administered through a naso-gastric (NG) feeding tube in the patients with minimally conscious state, then changed to oral route after proper swallowing and good gag reflex were ensured in the patient. The drug was slowly reduced over three weeks after neurological improvement in the patients. Positive result was determined by improvd GCS score of 2 and motor power by at least 1 British Medical Council (BMC) motor score. Improvement of deficits was evaluated in terms of fluency of speech for aphasia, task switching, digit span double tasking and trail-making test for cognition and attention, and functional independence measure score for motor functioning and self-independence.Results: Accelerated arousal was seen in 47.0% of cases (8/17) in 4e40 days. In 41.2% of cases (7/17), Glasgow outcome score (GOS) was improved to 4/5 in 90 days. Improvement in hemiparesis by at least 1 BMC score was seen in 55.6% of cases (5/9) in 40 days. Aphasia was improved in 80% of cases (4/5) in 7-30 days. Moderate improvement in cognitive impairment was seen in 66.7% of cases (2/3) in 14e20 days. Improvement in memory was observed in 50% of cases (1/2) in over 30 days. No cases were withdrawn from the study because of adverse reactions of the drug. There was no mortality in the study group.Conclusion: Bromocriptine improves neurological sequelae of traumatic brain injury as well as theoverall outcome in the patients. If medication is given to promote recovery and treat its associateddisabilities, clinicians should thoroughly outline the goals and closely monitor adverse effects.     

术后谵妄老年病人脑葡萄糖代谢的变化及右美托咪定对其影响

目的 探讨术后谵妄老年病人脑葡萄糖代谢的变化及右美托咪定对其影响.方法 择期全麻下行腹部手术的老年病人,性别不限,BMI 19～ 25 kg/m2,年龄65～ 85岁,ASA分级Ⅰ或Ⅱ级.术后2d内评价谵妄的发生情况,将术后谵妄病人采用随机数字表法,随机分为谵妄组(D组,n=13)和右美托咪定组(Dex组,n=16).另选术后没有发生谵妄的病人13例作为对照组(C组).Dex组在谵妄发生后经10 min静脉输注右美托咪定负荷量1μg/kg,随后以0.2～ 0.7 μg·kg-·h-1速率输注.谵妄发生期间采用18氟-脱氧葡萄糖行正电子发射断层显像,分析双侧顶叶、颞叶和额叶葡萄糖标准摄取值,以反映葡萄糖代谢率.结果 Dex组所有病人于给予右美托咪定后30 min内控制了谵妄.术后谵妄病人脑葡萄糖代谢降低的脑区主要集中在顶叶、颞叶和额叶.D组和Dex组双侧顶叶、颞叶和额叶葡萄糖代谢率低于C组(P＜ 0.05);Dex组双侧顶叶、颞叶、额叶葡萄糖代谢率高于D组(P＜0.05).结论 术后谵妄老年病人脑葡萄糖代谢率明显降低,右美托咪定可控制老年病人术后谵妄发生.     

Effect of Xingnaojing injection on cerebral edema and blood-brain barrier in rats following traumatic brain injury

Objective：To explore the effects of Xingnaojing injection on cerebral edema and blood-brain barrier （BBB） in rats following traumatic brain injury （TBI）.Methods： A total of 108 adult male Sprague-Dawley rats were used as subjects and randomly assigned to three groups：sham-operation,TBI and Xingnaojing injection was set up by the improved device of Feeney＇s weightcontent and BBB permeability expressed as Evans blue content were measured at 1, 3, 5 and 7 days after surgery.Results： In sham-operation group, brain water content and Evans blue content in brain tissue were 78.97%±1.22%and 5.13μg±0.71μg. Following TBI, water content in brain tissue was increased significantly at 1, 3, 5 and 7 days （83.49%±0.54%, 82.74%±0.72%, 80.22%±0.68%, 79.21%±0.60%）, being significantly higher than that in sham operation group （P〈0.05）. Evans blue content was increased in TBI group （16.54 μg±0.60 μg, 14.92μg±0.71μg, 12.44 μg ±0.92μg, 10.14μg±0.52 μg） as compared with sham-operation group（P〈0.05）. After treatment with Xingnaojing injection, brain water content decreased as compared with TBI group （81.91%±1.04%, 80.38%±0.72%, 79.54%±0.58%,78.60%±0.77%, P〈0.05）. Xingnaojing injection also reduced the leakage of BBB as compared with TBI group （15.11 μg± 0.63 μg, 13.62 μg±0.85μg, 10.06 μg±0.67 μg, 9.54 μg±0.41 μg,P〈0.05）.Conclusion： Xingnaojing injection could alleviate cerebral edema following TBI via reducing permeability ofBBB.     

Effect of intracranial pressure and cerebral perfusion pressure on outcome prediction of severe traumatic brain injury

ｒａｕｍａｔｉｃｂｒａｉｎｉｎｊｕｒｙｉｓｏｎｅｏｆｔｈｅｌｅａｄｉｎｇｃａｕｓｅｓｏｆｄｅａｔｈｉｎｔｈｅｉｎｄｕｓｔｒｉａｌｉｚｅｄｗｏｒｌｄａｎｄｃｏｓｔｓｍｏｒｅｔｈａｎｔｅｎｂｉｌｌｉｏｎＵＳｄｏｌｌａｒｓｉｎｔｈｅＰｅｏｐｌｅ ｓＲｅｐｕｂｌｉｃｏｆＣｈｉｎａｅａｃｈｙｅａｒ .Ｆｕｒｔｈｅｒｍｏｒｅ ,ｔｈｏｕｓａｎｄｓｏｆｓｕｒｖｉｖａｌｓａｒｅｌｉｖｉｎｇｗｉｔｈｌｏｎｇ ｔｅｒｍｄｉｓａｂｉｌｉｔｉｅｓｆｒｏｍｔｒａｕｍａｔｉｃｂｒａｉｎｉｎｊｕｒｙ .Ｔｈｅｉｍｐａｃｔｏｆｓｅｃｏ…     

血管内热交换降温对患者重型外伤性脑损伤的影响

目的 探讨血管内热交换降温对患者重型外伤性脑损伤的影响.方法 选择格拉斯哥昏迷评分(GCS评分)3～8分的重型外伤性脑损伤患者20例,采用随机数字表法,将患者随机分为冰袋降温组(IBC组)和血管内热交换降温组(EVC组),每组10例.IBC组术后采用冰袋降温,EVC组于手术开始时采用血管内热交换技术进行34℃亚低温治疗,维持至术后48 h.于术前10 min(基础状态)和术后24、48、72、96 h时取外周静脉血样,采用酶联免疫法测定血清神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)和S-100B的浓度.分别于术前10 min和术后8、12、24、48、72 h时记录HR、MAP、颅内压(ICP)和脑灌注压(CPP),于术前10 min和术后12、24、48、72 h时行GCS评分,术后6个月行格拉斯哥预后评分(GOS评分).结果 与IBC组比较,EVC组术后8 h和12 h时HR降低,术后72 h时MAP升高,术后12、24、48和72 h时ICP降低,CPP升高,术后24、48、72和96 h时NSE的浓度及术后48、72、96 h时MBP和S-100B浓度降低,术后6个月GOS评分升高(P＜0.05或0.01);与基础状态比较,IBC组术后12 h时GCS评分降低,术后8、12、24、48、72 h时HR升高,术后24、48、72、96 h时NSE和S-100B的浓度及术后48、72、96 h时MBP浓度升高,EVC组术后48、72 h时HR升高,术后72h时MBP及术后48 h时S-100B浓度升高(P＜0.05或0.01).结论 通过血管内热交换降温技术进行34℃亚低温可有效减轻患者重型外伤性脑损伤的程度.

Abstract：

Objective To investigate the effects of mild hypothermia induced by endovascular cooling with heating exchange catheters on severe traumatic brain injury in patients. Methods Twenty patients with severe traumatic brain injury aged 18-60 yr were randomly divided into 2 groups (n=10 each):ice bay cooling group (group IBC) and endovascular cooling group (group EVC).The state of consciousness was scored on a Glasgow coma scale (GCS).The patients had GCS scores of 3-8. The patients underwent emergency surgery.A probe of intracranial pressure monitor was placed during operation.In group EVC intravascular heat exchange catheters were inserted via femoral vein and connected to intravascular heat exchange system (CoolGard 3000, Alsius, USA). In group EVC body temperature was reduced to 34℃ and maintained at this level for 48 h. MAP, HR, body temperature and intracranial pressure (ICP) were continuously monitored and cerebral perfusion pressure (CPP) was calculated. Blood samples were taken from peripheral vein for determination of serum concentrations of neuron specific enolase (NSE), myelin basic protein (MBP) and S-100B (by enzyme linked immunosorbent assay) and GCS scores were assessed at 10 min before (baseline) and 12, 24, 48 and 72 h after operation. The state of consciousness was again assessed 3 months after operation and scored on Glasgrow outcome scale(GOS). Results ICP was significantly lower and CPP was higher after operation in group EVC than in group IBC. Serum concentrations of NSE, MBP and S-100B were significantly lower after operation in group EVC than in group IBC. Conclusion Mild hypothermia induced by endovascular cooling with heating exchange catheters can effectively reduce severe traumatic brain injury in patients.