Application Of NIRS Cerebral Oxygen Monitoring Technology In Postoperative Patients With Aneurysmal Subarachnoid Hemorrhage

Objective:NIRS cerebral oxygen monitoring technology bed side,continuous monitoring of patients with aneurysmal subarachnoid hemorrhage(aSAH)postoperative changes in the condition,dynamic observation and recording of local tissue saturation(TOI)changes,study the application of NIRS cerebral oxygen monitoring technology in patients with aSAH after surgery;study the real-time monitoring of cerebral oxygen monitor in patients with aSAH postoperative cerebral vasospasm lesions,evaluate the clinical diagnosis and treatment effect of patients with aSAH and recovery after discharge;explore the clinical significance and value of NIRS cerebral oxygen monitoring technology after aSAH in the treatment.Methods:1.Forty patients with aSAH were selected as the study subjects,and all selected patients were admitted to the neurosurgical intensive care unit of the Affiliated Hospital of Hebei University from December 2019 to August 2020.Inclusion criteria:1)Meet the 2015 Chinese Classification of Cerebrovascular Diseases in hemorrhagic cerebrovascular disease:subarachnoid hemorrhage:aneurysm rupture;2)18≤age≤75 years old,male or female;3)The onset time of the subject is not more than 1 day from admission;4)There are clear CT and other imaging data to prove aSAH Fisher Ⅲ;5)Patients with reduced bone flap after aneurysm clipping.Exclusion criteria:1)head and neck skin disease affecting the probe paste;2)allergic to 3M adhesive film or tape;3)traumatic subarachnoid hemorrhage;4)localized and/or with intracranial hematoma in patients with aSAH;5)intracranial infection in patients;6)irritability,mental disorders in patients can not cooperate to complete non-invasive cerebral oxygen monitoring.Withdrawal criteria:1)sudden changes in the condition endanger the patient’s life;2)halfway family members or the patient himself/herself request to discontinue the study;3)found to not meet the requirements during monitoring.2.Glasgow coma scale(GCS)was assessed after admission.Except for surgical contraindications,the same expert team performed surgical treatment.After operation,TOI of patients with aSAH was monitored with cerebral oxygen monitor,and transcranial doppler ultrasonography was performed.Monitoring mode:Monitor twice a day for 15 minutes for 10 consecutive days,and continuously monitor when the patient’s condition changes suddenly.Precautions for the application of Band-less Cerebral Oxygen Monitor Probe:1)use 75%alcohol for degreasing at the application site;2)adhere the probe in strict accordance with the instructions for use of Band-less Cerebral Oxygen Monitor;3)the probe shall be closely attached to the skin,otherwise the accuracy of data will be affected;4)the application position is on the forehead.According to the condition of cerebral vasospasm after aSAH,oral,intravenous or pumping drugs for the prevention and treatment of cerebral vasospasm were given under trans cranial Doppler ultrasound monitoring.Dynamically observe and record the TOI monitoring value in the cerebral oxygen momitor.Head CT was performed at any time when the condition changed,and the clinical treatment was adjusted according to the results of head CT.Patients discharged 6 months were assessed for recovery with the Glasgow outcome score(GOS).To analyze the adjuvant therapeutic effect of NERS cerebral oxygen monitoring technique in the treatment of aSAH and to explore its clinical application value.Results:Forty patients with aneurysmal sub arachnoid hemorrhage were finally included in this study,and all patients underwent noninvasive cerebral oxygen monitoring.The TOI values were 63.33%?.71%for anterior cerebral artery aneurysm,63.91%+6.24%for anterior communicating artery aneurysm,66.00%±7.39%for middle cerebral artery aneurysm,64.75%+ 7.46%for posterior cerebral artery aneurysm,and 65.79%±6.57%for internal carotid-posterior communicating artery.The correlation coefficient between the score of GCS score recorded at admission and TOI was 0.599(P<0.01,95%CI:0.396-0.747).The correlation coefficient between the mean TOI value and the mean flow velocity measurement of middle cerebral artery blood was-0.629(P<0.01,95%CI:-0.801--0.431).The mean TOI was 67.59%+4.85%in patients with good prognosis and 59.69%+6.86%in patients with poor prognosis,and the difference had statistical significance(t=4.205,P<0.01).There was no death during hospitalization.The discharged patients underwent GOS prognosis score 6 months after discharge.There were 27 patients with GOS score of 4-5,that is,27 patients with good prognosis,with good prognosis rate of 67.5%.There were 13 patients with GOS score of 1-3,that is,13 patients with poor prognosis,with poor prognosis rate of 32.5%.A total of 2 patients died after discharge,with fatality rate of 5%.The correlation coefficient between TOI and the prognosis of patients with aneinysmal subarachnoid hemorrhage was 0.710(P<0.01,95%CI:0.454-0.854).The area under the ROC curve of TOI in predicting good patient prognosis(GOS:4-5)was 0.809(P<0.01,95%CI:0.644-0.974),the optimal cut-off for prediction was 63.5%,its sensitivity was 85.2%,and its specificity was 76.9%.Conclnsion:1.NIRS cerebral oxygen monitoring technology can reflect the patient’s state of consciousness,mean velocity of middle cerebral artery blood flow and cerebral vasospasm,which is convenient for clinicians to observe and evaluate the changes in the condition of patients with aSAH after surgery;NIRS cerebral oxygen monitoring technology can reflect patients with aneurysmal subarachnoid hemorrhage at different tumor sites and can evaluate the prognosis of patients.2.NIRS cerebral oxygen monitoring technology can realize the continuous monitoring of patients with aneurysmal subarachnoid hemorrhage at the bedside after operation,which can timely determine the changes in the patient’s condition after operation and has great clinical application value.