The Influence Of The Course And Severity Of Brain Injury On The Occurrence Of Acute Gastrointestinal Injury After Traumatic Brain Injury

Background The close structural and functional association and interaction between the brain and the intestine is called the brain-gut axis.The neurobiochemical basis of brain-gut interaction includes the hypothalamic-pituitary-adrenal axis(HPA axis),the sympathetic nervous system,the parasympathetic nervous system(vagus nerve),the enteric nervous system and the gut microorganism.Previous studies have shown that the gastrointestinal tract is a new window for the assessment or prognosis of brain diseases or injuries.Traumatic brain injury(TBI)is a common clinical trauma with three characteristics of high incidence rate,disability rate and mortality.At present,its pathophysiological mechanism has not been fully elucidated.To explore the influence of the course of disease and the severity of brain injury after TBI on the occurrence of AGI after TBI,so as to explore the enterogenous indications for the evaluation and prognosis of TBIObjective To investigate effects of severity and temporal progression of traumatic brain injury on acute gastrointestinal injury.Methods A retrospective study was conducted to analyze the clinical data of182 patients with traumatic brain injury(TBI)in central ICU,surgical ICU and neurosurgical ICU of the First Affiliated Hospital of Chongqing Medical University from July 2018 to July 2019.Demographic data were recorded.Brain function and gastrointestinal function were evaluated on day 1,3,and 7 of post-trauma.Brain function was classified into light,moderate or severe level according to the Glasgow Coma Scale(GCS).The evaluation of intestinal function was based on the grade of acute gastrointestinal injury of the European Society of Critical Care Medicine and gastrointestinal bleeding.The related factors affecting GCS and the effect of AGI on the prognosis of TBI patients was analyzed.The incidence of acute gastrointestinal injury was compared at different time points.The incidence rates of acute gastrointestinal injury and gastrointestinal bleeding were compared at different time points and different degrees of TBI.Results(1)GCS was positively correlated with APACHE,SOFA,AGI and procalcitonin.There was no correlation with gender,co-existing diseases,site of brain injury,previous history of digestive tract,smoking,alcoholconsumption,albumin and hemoglobin.There was a negative correlation with age and previous brain history.(2)The AGI incidence on day 1,3 and7 after TBI was 75.8%,94.5% and 87.9%,respectively.The AGI incidence on day 3 was significantly higher than those on day 1 and 7(P=0.000).(3)The incidence of gastrointestinal bleeding after TBI was 21.98%,32.97%,and 62.63% on day 1,3,and 7,respectively,which was significantly higher than those on day 1 and 3(P=0.000).(4)The incidence of AGI after TBI was 90.00%,97.92%,95.00% in the severe group on day 1,3,and 7,respectively,which was significantly higher than those in the moderate(65.38%,89.29%,89.47%)and mild(64.00%,93.33%,50.00%)TBI patients at the corresponding time point(P=0.000).(5)The incidence of gastrointestinal bleeding after TBI was 45.83% and 78.33% in severe patients on day 3 and 7,respectively,which were significantly higher than those in moderate and mild TBI patients.However,there was no statistically significant difference in the incidence of gastrointestinal bleeding among the three groups on day 1(p > 0.05).(6)The higher the incidence of AGI,the higher APACHE score and SOFA score(P <0.05).Conclusion The course of disease and severity of brain injury after TBI significantly affect the incidence of AGI and gastrointestinal bleeding.AGI aggravated the prognosis of patients with TBI.