心脏骤停后综合征患者的ICU脑复苏优化治疗

目的 探讨ICU优化治疗对心脏骤停后综合征患者脑复苏的治疗效果.方法 34例心肺复苏成功,恢复自主循环并维持超过24 h以上,年龄大于18岁的成年患者(门急诊收治26例,院内转科8例),采用优化综合治疗措施,包括低温、脱水、脑复苏等,并于2周后根据格拉斯哥-比兹堡法评估脑复苏效果.结果 34例患者脑功能完好者7例(20.6％),中度脑功能残障4例(11.8％),严重脑功能残障6例(17.6％),昏迷8例(23.5％),死亡9例(26.5％).良好神经学结局者11例(32.4％).良好神经学结局组和不良结局组患者比较,复苏开始时间、机体恢复自主循环后48 h的GCS评分、自主循环状态差异有统计学意义(P＜0.05).结论 ICU的优化治疗措施有利于心脏骤停后综合征患者的脑复苏,但脑复苏结局还取决于心跳骤停的原因、复苏开始时间以及早期复苏的质量.     

心脏骤停复苏后低温林格液诱导亚低温治疗的实施与护理

目的观察心脏骤停心肺复苏后患者应用低温林格液诱导亚低温的效果和安全性。方法将39例心脏骤停心肺复苏后患者随机分成观察组(19例)和对照组(20例)。观察组自主循环恢复后立即快速静脉输注4℃林格液(20mL/kg,30～50mL/min)诱导降温,使患者核心体温降到目标温度(32～34℃);对照组采用传统的体外降温法(如头部冰帽,颈部、腹股沟冰敷)诱导降温;两组均用亚低温治疗仪维持24h后开始缓慢复温。记录两组从开始降温到达到目标温度的时间、生命体征的变化以及3个月后的随访结果。结果观察组未发生快速输液引起的肺水肿;达到目标温度的时间显著短于对照组,血氧饱和度显著高于对照组(均P<0.01);3个月后大脑功能级别评分良好的例数多于对照组。结论快速静脉输注低温林格液诱导亚低温治疗安全、有效;密切观察患者生命体征、预防肺水肿,降温过程中防治寒颤、缓慢复温是护理重点。     

Mild therapeutic hypothermia induced by using ice-cold Ringer's solution after resuscitation of cardiac arrest : nursing care

目的 观察心脏骤停心肺复苏后患者应用低温林格液诱导亚低温的效果和安全性.方法 将39例心脏骤停心肺复苏后患者随机分成观察组(19例)和对照组(20例).观察组自主循环恢复后立即快速静脉输注4℃林格液(20 mL/kg,30～50 mL/min)诱导降温,使患者核心体温降到目标温度(32～34℃)；对照组采用传统的体外降温法(如头部冰帽,颈部、腹股沟冰敷)诱导降温；两组均用亚低温治疗仪维持24 h后开始缓慢复温.记录两组从开始降温到达到目标温度的时间、生命体征的变化以及3个月后的随访结果.结果 观察组未发生快速输液引起的肺水肿；达到目标温度的时间显著短于对照组,血氧饱和度显著高于对照组(均P＜0.01);3个月后大脑功能级别评分良好的例数多于对照组.结论 快速静脉输注低温林格液诱导亚低温治疗安全、有效；密切观察患者生命体征、预防肺水肿,降温过程中防治寒颤、缓慢复温是护理重点.     

成年人心搏骤停复苏后治疗性低温的实施进展

背景 心脏事件的高发生率和低生还率严重威胁着人类健康.研究表明低温治疗有望改善心肺复苏(eardiopulmonary resuscitation,CPR)后患者的神经功能恢复.在临床中治疗性低温的具体实施仍存在较多的争议.目的 就成年人心搏骤停复苏后治疗性低温的具体实施进展作一综述.内容 对于初始为室颤的院外心搏骤停后自主循环恢复的成年人昏迷患者,应尽快予低温治疗,对于院外非室颤或院内心搏骤停患者亦可实施治疗性低温.目前仍无资料表明哪一种降温方法最好,诱导达到靶目标温度后,维持中心体温在32℃～34℃并至少持续12 h～24 h,缓慢复温,密切监测,防止并及时处理并发症.趋向 低温治疗是CPR后患者脑保护的一项重要措施,其应用的时机、方式、持续时间、副作用的防治等,仍需要大量循证学依据.     

心脏骤停继发腺垂体功能减退和尿崩症1例报告

收治1例心脏骤停后继发腺垂体功能减退和尿崩症两种致命的并发症的病例,报告如下。 1病历简介 患者男,70岁,因意识模糊4 h,呼吸心跳停止3.5 h,于2013年3月29日入院。急诊来院途中出现颜面青紫,呼吸停止,继而心脏骤停。给予紧急气管插管,心肺复苏10 min后自主循环恢复。     

体外心肺复苏的研究进展北大核心CSCD

体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)是指在传统心肺复苏后仍未恢复持续自主循环的心脏骤停患者中应用体外膜肺氧合技术,以提供更高的心输出量及有效气体交换,保证器官灌注。近年来ECPR在患者救治过程中取得了良好效果。ECPR常见适应证包括年龄<70岁,有可电复律的初始心律,有目击者的心脏骤停,5 min内旁观者心肺复苏,心肺复苏后15 min内未恢复持续自主循环。准确判断ECPR应用指征、迅速安装体外生命支持设备以及高质量管理是改善预后的关键。本文就ECPR的开始时机和患者选择、近期结果、影响因素及并发症进行综述。     

不同给药途径对肾上腺素心肺复苏效果的影响

目的 评价不同心内途径注射首剂肾上腺素对心肺复苏(cardiopulmonary resuscitation,CPR)效果的影响.方法 筛选2007年12月～2013年12月院内心搏骤停接受CPR病例753例,依据CPR时首剂肾上腺素注射途径,分为中心静脉给药组(CV组,315例)、外周静脉给药组(PV组,271例)及心内注射组(ICI组,167例).进而根据年龄、性别、心搏骤停前左心室舒张末期内径(left ventricular end diastolic dimension,LVEDD)及左心室射血分数(left ventricular ejection fraction,LVEF)4项因素进行匹配,在3组病例中各选择82例共246例进行统计学研究.比较3组自主循环恢复比例、所需时间、电除颤次数及肾上腺素使用剂量,记录心内途径注射并发症.比较3组CPR后l、24 h及出院存活率.结果 PV、CV、ICI 3组自主循环恢复率分别为36.5％、39.0％、43.9％,所需时间分别为(6.8±1.3)、(5.5±1.5)、(4.1±1.1) min,电击次数分别为(5.0±1.5)、(4.0±1.2)、(3.0±1.3)次,肾上腺素使用剂量分别为(7.5±1.8)、(6.3±1.2)、(5.0±1.5) mg.PV组CPR后1、24h及出院存活率分别为34.1％、30.4％、25.6％,CV组CPR后1、24 h及出院存活率分别为36.5％、24.4％、24.3％,ICI组CPR后1、24 h及出院存活率分别为40.2％、39.0％、25.6％.与PV、CV组比较,ICI组自主循环恢复比例最高(P＜0.05),所需时间最短(P＜0.05),电除颤次数和肾上腺素使用剂量最少(P＜0.05),CPR后1、24 h存活率最高(P＜0.05).CV组CPR后24 h存活率最低(P＜0.05);余指标优于PV组,差异有统计学意义(P＜0.05).3组出院存活率比较,差异无统计学意义(P＞0.05).ICI组1例心包内出血＞50 ml行穿刺引流预后良好.结论 心搏骤停暂无静脉给药途径时,心内注射首剂肾上腺素可有效提高CPR成功率.     

心肺复苏后血清脑钠肽水平预测脑损伤程度临床分析

目的探讨心肺复苏后血清脑钠肽水平对预测脑损伤程度的价值。方法将接受心肺复苏的75例患者分为轻度脑损伤组、中度脑损伤组和重度脑损伤组,各25例。选取同期健康体检的人群25例作为对照组。对比各组自主循环恢复后各个时间血清脑钠肽水平。结果脑损伤组自主循环恢复后2 h、4 h、8 h、12 h、48 h血清脑钠肽水平均高于对照组,差异有统计学意义(P0.05);且轻度、中度、重度脑损伤组伴随脑损伤程度越重,血清脑钠肽水平越高,差异有统计学意义(P0.05)。各时间段血清脑钠肽水平与GCS评分相比差异均有统计学意义(P0.05)。血清脑钠肽水平与GCS评分存在负相关关系。结论心肺复苏后血清脑钠肽水平可有效预测患者脑损伤程度,血清脑钠肽水平越高则表明脑损伤程度越重。     

亚低温治疗对急性Stanford A型主动脉夹层患者围术期炎症反应及预后影响的随机对照试验

目的探讨亚低温治疗对急性Stanford A型主动脉夹层患者围术期炎症反应、器官功能及预后的影响。方法纳入2017年2月至2018年2月我科急性Stanford A型主动脉夹层患者56例,随机分为对照组及试验组,每组各28例。对照组:男20例、女8例,年龄(51.5±8.7)岁;患者在术中经历深低温停循环后,将体温复温至36～37℃,并延续至术后24 h。试验组,男24例、女4例,年龄(53.3±11.2)岁;患者体温复温至34～35℃,余同对照组;比较两组患者预后。结果两组患者临床资料差异无统计学意义。与对照组相比,在术后第24 h,试验组外周血基质金属蛋白酶(MMPs)水平更低(P=0.008)。试验组患者术后苏醒时间更短(P=0.008),血流感染的发生率更低(P=0.019),但两组患者的谵妄发生率、急性肾损伤(AKI)发生率、肝功能不全发生率、机械通气时间、住ICU时间及病死率差异均无统计学意义。两组患者术后24 h内的胸腔引流量差异均无统计学意义,且均未发生寒战。结论亚低温治疗能够缩短急性Stanford A型主动脉夹层患者术后的苏醒时间,降低血流感染的发生率,且不会引起胸腔引流量增多或寒战。     

纳洛酮早期应用于心肺脑复苏中的疗效观察

目的探讨纳洛酮在早期心肺脑复苏中的治疗效果。方法45例心脏骤停患者随机分为两组：治疗组（23例）予纳洛酮治疗及常规复苏治疗,对照组（22例）仅予常规复苏治疗,观察两组患者的自主循环恢复率、自主呼吸恢复率、意识恢复时间、复苏成功率及48h存活率。结果治疗组自主循环恢复19例（82．61％）、自主呼吸恢复13例（56．52％）、意识恢复时间（35．0±12．5）min、复苏成功12例（52．17％）及48h存活12例（52．17％）,与对照组[分别为11例（50．（）0％）、6例（27．27％）、（48．0±11．8）min、5例（22．73％）、4例（18．18％）]比较差异均有统计学意义（P＜0．05）。结论纳洛酮早期应用于心肺脑复苏疗效显著且安全。     

Therapeutic hypothermia after out-of-hospital cardiac arrest: experiences with patients treated with percutaneous coronary intervention and cardiogenic shock

BACKGROUND: Therapeutic hypothermia has been shown to increase survival after out-of-hospital cardiac arrest (OHCA). The trials documenting such benefit excluded patients with cardiogenic shock and only a few patients were treated with percutaneous coronary intervention prior to admission to an intensive care unit (ICU). We use therapeutic hypothermia whenever cardiac arrest patients do not wake up immediately after return of spontaneous circulation. METHODS: This paper reports the outcome of 50 OHCA patients with ventricular fibrillation admitted to a tertiary referral hospital for immediate coronary angiography and percutaneous coronary intervention when indicated. Patients were treated with intra-aortic balloon counterpulsation (IABP) (23 of 50 patients) if indicated. All patients who were still comatose were treated with therapeutic hypothermia at 32-34 degrees C for 24 h before rewarming. The end-points were survival and cerebral performance category (CPC: 1, best; 5, dead) after 6 months. RESULTS: Forty-one patients (82%) survived until 6 months. Thirty-four patients (68%) were in CPC 1 or 2, and seven (14%) were in CPC 3. Of the 23 patients treated with IABP, 14 (61%) survived with CPC 1 or 2. In patients not treated with IABP, 20 patients (74%) survived with CPC 1 or 2. Forty patients (80%) developed myocardial infarction. Percutaneous coronary intervention was performed in 36 patients (72%). CONCLUSION: In OHCA survivors who reached our hospital, the survival rate was high and the neurological outcome acceptable. Our results indicate that the use of therapeutic hypothermia is justified even in haemodynamically unstable patients and those treated with percutaneous coronary intervention.     

Outcome, timing and adverse events in therapeutic hypothermia after out-of-hospital cardiac arrest

Background: Therapeutic hypothermia (TH) after cardiac arrest protects from neurological sequels and death and is recommended in guidelines. The Hypothermia Registry was founded to the monitor outcome, performance and complications of TH.
Methods: Data on out-of-hospital cardiac arrest (OHCA) patients admitted to intensive care for TH were registered. Hospital survival and long-term outcome (6–12 months) were documented using the Cerebral Performance Category (CPC) scale, CPC 1–2 representing a good outcome and 3–5 a bad outcome.
Results: From October 2004 to October 2008, 986 TH-treated OHCA patients of all causes were included in the registry. Long-term outcome was reported in 975 patients. The median time from arrest to initiation of TH was 90 min (interquartile range, 60–165 min) and time to achieving the target temperature (≤34 °C) was 260 min (178–400 min). Half of the patients underwent coronary angiography and one-third underwent percutaneous coronary intervention (PCI). Higher age, longer time to return of spontaneous circulation, lower Glasgow Coma Scale at admission, unwitnessed arrest and initial rhythm asystole were all predictors of bad outcome, whereas time to initiation of TH and time to reach the goal temperature had no significant association. Bleeding requiring transfusion occurred in 4% of patients, with a significantly higher risk if angiography/PCI was performed (2.8% vs. 6.2% P =0.02).
Conclusions: Half of the patients survived, with >90% having a good neurological function at long-term follow-up. Factors related to the timing of TH had no apparent association to outcome. The incidence of adverse events was acceptable but the risk of bleeding was increased if angiography/PCI was performed.     

Comparable Outcome of Out‐of‐Hospital Cardiac Arrest and In‐Hospital Cardiac Arrest Treated With Extracorporeal Life Support

Extracorporeal life support (ECLS) has shown benefits in the management of refractory in‐hospital cardiac arrest (IHCA) by improving survival. Nonetheless, the results concerning out‐of‐hospital refractory cardiac arrests (OHCA) remain uncertain. The aim of our investigation was to compare survival between the two groups. We realized a single‐center retrospective, observational study of all patients who presented IHCA or OHCA treated with ECLS between 2011 and 2015. Multivariate analysis was realized to determine independent factors associated with mortality. Over the 4‐year period, 65 patients were included, 43 in the IHCA group (66.2%), and 22 (33.8%) in the OHCA group. The duration of low flow was significantly longer in the OHCA group (60 vs. 90 min, P = 0.004). Survival to discharge from the hospital was identical in the two groups (27% in the OHCA group vs. 23% in the IHCA group, P = 0.77). All surviving patients in the OHCA group had a cerebral performance categories score of 1–2. In multivariate analysis, we found that the initial lactate level and baseline blood creatinine were independently associated with mortality. We found comparable survival and neurological score in patients who presented IHCA and OHCA treated with ECLS. We believe that appropriate selection of patients and optimization of organ perfusion during resuscitation can lead to good results in patients with OHCA treated with ECLS.     

Extracellular Brain pH and Outcome following Severe Traumatic Brain Injury

The ability to measure brain tissue chemistry has led to valuable information regarding pathophysiological changes in patients with traumatic brain injury (TBI). Over the last few years, the focus has been on monitoring changes in brain tissue oxygen to determine thresholds of ischemia that affect outcome. However, the variability of this measurement suggests that it may not be a robust method. We have therefore investigated the relationship of brain tissue pH (pH(b)) and outcome in patients with TBI. We retrospectively analyzed prospectively collected data of 38 patients admitted to the Neurosciences Critical Care Unit with TBI between 1998 and 2003, and who had a multiparameter tissue gas sensor inserted into the brain. All patients were managed using an evidence-based protocol targeting CPP > 70 mm Hg. Physiological variables were averaged over 4 min and analyzed using a generalized least squares random effects model to determine the temporal profile of pH(b) and its association with outcome. Median (IQR) minimum pH(b) was 7.00 (6.89, 7.08), median (IQR) maximum pH(b) was 7.25 (7.18, 7.33), and median (IQR) patient averaged pH(b) was 7.13 (7.07, 7.17). pH(b) was significantly lower in those who did not survive their hospital stay compared to those that survived. In addition, those with unfavorable neurological outcome had lower pH(b) values than those with favorable neurological outcome. pH(b) differentiated between survivors and non-survivors. Measurement of pH(b) may be a useful indicator of outcome in patients with TBI.     

Welcher Patient profitiert von einem Transport unter laufender kardiopulmonaler Reanimation?

Background

Mortality in patients with out-of-hospital cardiac arrest (OHCA) remains very high despite advances in resuscitation algorithms. Most of these patients die at the scene and do not reach hospital. It is currently the subject of discussion whether transport to hospital with ongoing cardiopulmonary resuscitation (CPR) improves survival and neurological outcome in patients with OHCA.

Objective

The aim of this study was to identify predictors of survival and good neurological outcome in patients after OHCA who were transported to hospital with ongoing CPR.

Patients and methods

A total of 70 consecutive patients with refractory OHCA (mean age 54.7?±?15 years) transported to hospital with ongoing CPR were retrospectively analyzed. Neurological outcome was assessed after 30 days based on the Glasgow-Pittsburgh cerebral performance category (CPC).

Results

After 30 days 82.9% of the patients enrolled in the trial died (CPC score of 5), 8 patients (11.4%) showed a good neurological recovery with CPC scores of 1–2 and 4 patients (5.7%) had a poor neurological outcome with CPC scores of 3–4. Predictors of good neurological outcome were witnessed arrest, initial defibrillatable rhythm and serum lactate levels on admission. In all patients with good outcome, the index event for OHCA was from cardiac causes.

Conclusion

Selected patient collectives can benefit from transport to hospital with ongoing cardiopulmonary resuscitation (CPR).

     

Effects of body temperature on accuracy of continuous cardiac output measurements.

Intermittent measurement of cardiac output is routine in the critically ill surgical patient. A new catheter allows real-time continuous measurement of cardiac output. This study evaluated the impact of body temperature variation on the accuracy of these measurements compared to standard intermittent bolus thermodilution technique. This prospective study in a university hospital surgical intensive care unit included 20 consecutive trauma patients. Data were collected with pulmonary artery catheters, which allowed both continuous (COC) and bolus (COB) thermodilution measurements. The catheter was placed through either the subclavian or internal jugular vein. Measurements for COB were performed using a bolus (10 cm3) of ice-cold saline with a closed-injectate delivery system at end-expiration. Computer-generated curves were created on a bedside monitor, and the average of three measurements within 10% of one another was used as COB. COC was determined as the average of the displayed CO before and after thermodilution CO measurements. Body temperature was measured from the pulmonary artery catheter and was grouped as < or =36.5 degrees C, 36.6-38.4 degrees C, and > or =38.5 degrees C. COB and COC were compared for agreement by plotting the mean of the differences (COB - COC) between the methods. The differences were plotted against the average of each pair and analyzed with linear regression. One hundred seventy-eight paired measurements were made over a period of 1 to 3 days. CO ranged from 3.7 to 15.5 L/min. Eighty-one percent of measurements were at a temperature of 36.5-38.4 degrees C. Approximately 7% of measurements were at a temperature below 36.5 degrees C and 11.2% were in patients with a core temperature above 38.5 degrees C. Correlation between the two techniques was 0.96, 0.91, and 0.82 for temperatures of < or =36.5 degrees C, 36.6-38.4 degrees C, and > or = 38.5 degrees C, respectively. In conclusion, the COC measurements correlate well with COB in trauma patients with a core temperature < or =38.5 degrees C. The accuracy degraded at higher temperatures, which may be related to the smaller signal-to-noise ratio at elevated body temperatures.     

Advantages of subclavian artery perfusion for repair of acute type A dissection.

OBJECTIVE: Arterial perfusion through the right subclavian artery is proposed to avoid intraoperative malperfusion during repair of acute type A dissection. This study evaluated the clinical and neurological outcome of patients undergoing surgery of acute aortic type A dissection following subclavian arterial cannulation compared to femoral artery approach. METHODS: From 1/97 to 1/03, 122 consecutive patients underwent surgery for acute type A aortic dissection. Subclavian cannulation was performed in 62 versus femoral cannulation in 60 patients. Clinical characteristics in both groups were similar. Mean age was 61 years (SD+/-14 years, 72% male) and mean follow-up was 3 years (+/-2 years). Patient outcome was assessed as the prevalence of clinical complications, especially neurological deficits, mortality at 30 days, perioperative morbidity and time of body temperature cooling and analyzed by nominal logistic regression analysis for odds ratio calculation. RESULTS: Arterial subclavian cannulation was successfully performed without any occurrence of malperfusion in all cases. Patients undergoing subclavian cannulation showed an odds ratio of 1.98 (95% CI 1.15-3.51; P=0.0057) for an improved neurological outcome compared to patients undergoing femoral cannulation. Re-exploration rate for postoperative bleeding was significantly reduced in the subclavian group (P<0.0001), as well as occurrence of myocardial infarction (P<0.0001) and duration for body temperature cooling (P=0.004). The 30-day mortality of patients with femoral cannulation was significantly higher compared to patients with subclavian artery cannulation (24 versus 8%; P=0.0179). CONCLUSIONS: Arterial perfusion through the right subclavian artery provides an excellent approach for repair of acute type A dissection with optimized arterial perfusion body perfusion and allows for antegrade cerebral perfusion during circulatory arrest. The technique is safe and results in a significantly improved clinical and especially neurological outcome.     

Body warmer and upper extremities position affect the accuracy of cutaneous thermometers during anesthesia.

STUDY OBJECTIVE: To evaluate whether axillary skin temperature can accurately reflect distal esophageal temperature. DESIGN: Prospective, randomized study. SETTING: Teaching hospital. PATIENTS: 48 ASA physical status I and II adult patients undergoing abdominal surgery. INTERVENTIONS: Patients received standard general anesthesia. 19 patients had abducted upper extremities and an upper body surface warmer, 19 patients had abducted upper extremities with no upper body surface warmer, and 10 patients had adducted upper extremities with no upper body surface warmer. MEASUREMENTS AND MAIN RESULTS: The temperatures were measured 60 minutes after the induction of general anesthesia. There was no significant difference between axillary skin temperature (36 +/- 1.7) (degrees C) and core temperature (36 +/- 0.7) (degrees C) when the upper body surface warmer was used. There was no difference between axillary skin temperature (35.5 +/- 0.4) (degrees C) and core temperature (35.8 +/- 0.4) (degrees C) when upper extremity was adducted 0 degrees. CONCLUSIONS: At 0 degrees of arm adduction, or at 90 degrees using the upper body, forced-air surface warmer, axillary skin temperature accurately identified the core temperature in patients during general anesthesia.     

低体温对患者体感诱发电位的影响

目的 评价低体温对患者体感诱发电位(SSEP)的影响.方法 择期心脏手术患者13例,性别不限,年龄23～51岁,体重45～82 kg,ASA分级Ⅱ或Ⅲ级.麻醉诱导后测定双侧正中神经体感诱发电位:于Erb点和第2颈椎棘突分别放置臂丛和颈部记录电极,随后放置头皮电极,分别记录臂丛电位(N9)、颈髓电位(N13)和皮层电位(N20)的峰潜伏期和波幅.记录降温阶段和复温阶段达到目标体温(36、35、34、33 ℃)时的MAP、峰潜伏期和波幅.术后记录显性神经功能缺陷的发生情况.结果 降温阶段随体温降低,峰潜伏期延长,MAP降低(P＜0.05),波幅差异无统计学意义(P＞0.05);复温阶段随体温升高,峰潜伏期缩短(P＜0.05),MAP和波幅差异无统计学意义(P＞0.05);降温阶段峰潜伏期与体温呈负相关,相关系数分别为-0.673(N9)、-0.702(N13)、-0.702(N20)(P＜0.05),以体温为自变量X,峰潜伏期为因变量Y,得到直线回归方程分别为:Y9=-0.558X+28.994,YN13=-1.121X+53.242,YN20=-1.458X+72.036;复温阶段峰潜伏期与体温呈负相关,相关系数分别为-0.634(N9)、-0.619(N13)、-0.600(N20)(P＜0.05),直线回归方程分别为:YN9=-0.505X+27.313,YN13=-0.905X+46.249,YN20=-1.142X+61.668.所有患者术后均未发生神经系统功能缺陷.结论 低体温可延长SSEP峰潜伏期,对波辐无明显影响.

Abstract：

Objective To evaluate the effect of hypothermia on somatosensory evoked potentials (SSEPs). Methods Thirteen ASA Ⅱ or Ⅲ patients aged 23-51 yr weighing 45-82 kg scheduled for cardiac surgery were enrolled in this study. Bilateral median nerve SSEPs (N9, N13, N20) were recorded after induction.The MAP, peak latency and amplitude of N9, N13 and N20 were recorded when the target temperature (36, 35,34, 33 ℃ ) was reached during the cooling and rewarming periods. The neurological dysfunction was recorded after operation. Results The peak latency was prolonged and MAP was decreased with the decrease in the body temperature during the cooling period, the peak latency was shortened with the increase in the body temperature during the rewarming period ( P ＜ 0.05), but no significant change in the amplitudes was found ( P ＞ 0.05). The regression equation of the interaction between the peak latency and body temperature was YN9= -0.558X + 28.994(r=-0.673), YN13 =-1.121X+53.242 (r= -0.702) , YN20 = -1.458X+72.036(r= -0.702) during the cooling period (P ＜ 0.05), and YN9 = - 0.505X + 27.313 ( r = - 0.634), YN13 = - 0.905X + 46.249(r= -0.619), YN20 = - 1.142X + 61.668 (r= -0.600) during the rewarming period (P ＜0.05). No neurological dysfunction was found in all the patients. Conclusion Hypothermia can prolong the peak latency of SSEP and does not alter the SSEP amplitude.     

Brain abscess in 142 patients: factors influencing outcome and mortality

BACKGROUND: With the introduction of CT, stereotactic techniques, and broad-spectrum antibiotics, the outcome for brain abscess has dramatically improved. The purpose of this study was to identify prognostic factors by reviewing data on 142 patients with brain abscess. METHODS: Clinical data, including age, sex, medical history, duration of symptoms, initial neurological status, associated predisposing factors, laboratory data, treatment, and abscess characteristics, were considered as potential prognostic factors. A comparison was made between patients with favorable (GOS: moderate disability or good recovery) and those with unfavorable (GOS: death, persistent vegetative status, or severe disability) outcomes at discharge. Univariate (chi(2) analysis or Fisher's exact test) and multivariate logistic regression analyses were used to identify prognostic factors. Data were considered significant when the 2-tailed P value was lower than .05. RESULTS: There were 98 male and 44 female patients (male/female ratio, 2.2). Their average age at diagnosis was 41.5 years (range, 2-84 years). There were 105 patients with a favorable outcome and 37 with an unfavorable outcome. Both univariate and multivariate analyses indicated that patients who were male, had an initial GCS score >12, had no other septic complication, or had Gram-positive cocci grown in abscess cultures had better outcomes. No association was found between outcome and other factors, including age, focal neurological deficits, seizures, laboratory findings, characteristics of the abscesses, associated factors, and treatment modalities. CONCLUSIONS: With the advancement of imaging studies and broad-spectrum antibiotic therapies, the outcome of brain abscess depends on prompt awareness of the diagnosis and effective infection control.