Cohort Study On The Relationship Between The Severity Of Craniocerebral Injury And Sublingual Microcirculation

Objectives:To observe the correlation between different degrees of craniocerebral injury and sublingual microcirculation,explore the possibility of sublingual microcirculation monitoring the severity of craniocerebral injury,and add a new dimension for multimodal nerve monitoring.Methods:Single center,prospective,cohort study.Twenty nine patients with brain injury(including cerebral hemorrhage,cerebral infarction and brain injury)admitted to EICU of the First Affiliated Hospital of Kunming Medical University from January 1,2020 to January 1,2021 were enrolled.They were divided into three groups according to the GCS score on admission:group A(3-8 points),group B(9-12 points)and group C(13-15 points),Group A(n=13),group B(n=7)and group C(n=9).The de backer score(VD),total vascular density(TVD)and perfusion vascular density(PVD)were measured by optical fiber dark field imaging,and the arterial blood lactic acid value at admission was recorded.Results:1.There was no significant difference in gender among group A,group B and group C(P=0.560).There was no significant difference in age and lactic acid among group A,group B and group C(Age:P=0.508;Lac:P=0.892).2.By analysis of variance of completely randomized design data,there were significant differences in VD1,TVD1,PVD1,PVD2,VDA,TVDA,PVDA and PVDB among group A,group B and group C(P<0.001).Further LSD-t pairwise comparison showed that there were significant differences among group A,group B and group C(P<0.05).3.The mean value of PVD1 of large vessels(Group A,B,C:10.37mm/mm2,11.20mm/mm2,12.56mm/mm2)and PVD2(Group A,B,C:10.23mm/mm2,11.34mm/mm12,13.03mm/mm2)were higher than those of PVDA(Group A,B,C:3.68mm/mm2,5.05 mm/mm2,6.44mm/mm2)and PVDB(Group A,B,C:3.68mm/mm2),The mean value of TVD1 of large vessels(Group A,B,C:10.48mm/mm2,11.42mm/mm2,12.63mm/mm2)was higher than that of TVDA of small vessels(Group A,B,C:3.70mm/mm2,4.68mm/mm2,6.62mm/mm2).4.The changes of PVD1,PVD2,TVD1 and the changes of P VDA,PVDB,TVDA were similar in each group.Conclusions:1.The density of subcirculation vessels increased with the increase of GCS score.The method of measuring the subconral microcirculation should be considered when assessing the severity of brain injury;2.The abnormal decrease of microvessel density in patients with craniocerebral injury proves that sublingual arterioles or capillaries are occluded and microcirculation disturbance exists in different degrees,which may be related to different degrees of craniocerebral injury.