| Objective:1.To determine the characteristics of circadian rhythms of body temperature,heart rate,and blood pressure in patients with traumatic brain injury(TBI)during the acute phase(72 hours after admission).2.To evaluate the neurological function,quality of life and mental status of patients with TBI 3 months after injury,analyze the relevant influencing factors,and explore the correlation between the circadian rhythm of vital signs in the acute stage and its prognosis.Method:A prospective cohort study was conducted among 174 patients with TBI treated in neurosurgery of two class III class a general hospital in Fujian Province from May 2020 to December 2020.The patients were divided into three groups according to the Glasgow Coma Scale(GCS)score at admission.The patient’s body temperature,heart rate and blood pressure were continuously measured 72 hours after admission,and measured every 2 hours to collect the patient’s clinical data.The patients were followed up 3 months after injury,Outcomes were measured using the extended Glasgow Outcome Scale(GOS-E),the MOS item health survey(SF-36),hospital anxiety and Depression Scale(HADS),impact of Event Scale(IES-R)、Barthel Index(BI)was used to evaluate neurological function,quality of life,anxiety,depression,post-traumatic stress disorder(PTSD)and activities of daily living respectively.Halberg cosine analysis was used to analyze the rhythm changes of vital signs such as body temperature,heart rate and blood pressure,with P < 0.05 indicates the existence of circadian rhythm.According to the results of follow-up,patients were divided into good prognosis group and poor prognosis group of neurological function,anxiety symptom group and no anxiety symptom group,depression symptom group and no depression symptom group,post-traumatic stress disorder group and no posttraumatic stress disorder group.The circadian rhythm parameters of body temperature,heart rate and blood pressure between the groups were compared,and the associate factors affecting prognostic neurological function,quality of life mental psychology and daily living ability were analyzed.Results:174 patients with TBI were included,95 patients with mild TBI,29 patients with medium TBI and 50 patients with severe TBI.There were 137 males and 37 females,with an average age of(55.13 ± 16.48)years.During the follow-up period,15 cases fell off,7 cases refused to follow-up,9 cases could not be contacted by telephone,and 1 case had mental disorder.1.Halberg cosine analysis showed that the circadian rhythm of body temperature,systolic blood pressure and diastolic blood pressure existed in patients with mild TBI(P < 0.05),and the circadian rhythm of heart rate disappeared(P >0.05);The circadian rhythms of body temperature,systolic blood pressure and diastolic blood pressure existed in patients with moderate TBI(P < 0.05),and the circadian rhythms of heart rate and diastolic blood pressure disappeared(P > 0.05);The circadian rhythm of body temperature existed in patients with severe craniocerebral trauma(P < 0.05),and the circadian rhythm of heart rate,systolic blood pressure and diastolic blood pressure disappeared(P > 0.05).2.The Chi-square analysis results show that there were no significant difference in the cause of injury,ages,gender,with other injury,surgery,admission of ICU,with certainty artificial airway,use of machinical ventilation between groups of wih/without(all P > 0.05).temperature,heart rate,blood pressure rhythm.3.Results of follow-up outcomes at 3 months after injury: 43 patients(30.23%)had poor neurological prognosis.Sixty-one patients(47.29%)were able to complete daily activities independently,32 patients(21.83%)had mild dysfunction,9 patients(6.97%)had moderate dysfunction,and 27 patients(20.93%)had severe dysfunction.Twenty-six(24.07%)were positive for anxiety,28(25.93%)for depression,23(21.10%)for anxiety and depression disorder,and 20(18.34%)for post-traumatic stress disorder.Posttraumatic stress disorder symptoms were positive in 20 cases(18.3%).There were 4 cases of anxiety,depression and PTSD at the same time.4.Correlation analysis between rhythm changes of vital signs and prognosis in acute stage(1)The correlation between rhythm change of vital signs and clinical outcomeThe results showed that there was no statistically significant difference in,admission to ICU and length of hospital stay between groups of with and without body temperature rhythm(P > 0.05),but there was statistically significant difference between the change and in GOSE score(P < 0.05).There were statistically significant differences between the change of heart rate rhythm and in ICU stay,GOSE score and length of stay between groups of with and without heart rate rhythm(P < 0.05),while there were no significant differences in admission to ICU,GOSE score and length of hospital stay(P > 0.05).(2)Rhythm changes of body temperature,heart rate,blood pressure and the correlation between rhythm parameters and neurological function at 3 months in patients with craniocerebral trauma at acute stageThere were 43 cases in the poor prognosis group(GOSE< 4)and 99 cases in the good prognosis group(GOSE> 5).There were significant differences in amplitude,median and circadian rhythm quotient of body temperature circadian rhythm parameters,median and peak activity of heart rate circadian rhythm parameters between the two groups(P < 0.05).There were no statistical differences between the two groups in the peak phase of body temperature circadian rhythm parameters,the amplitude,circadian rhythm quotient and peak phase of heart rate circadian rhythm parameters,the amplitude,median,circadian rhythm quotient,peak activity and peak phase of systolic and diastolic blood pressure circadian rhythm parameters(P > 0.05).(3)Rhythm changes of body temperature,heart rate,blood pressure and the correlation between rhythm parameters and psychopathology of patients with craniocerebral trauma in acute stageTwenty-six cases(24.07%)had anxiety symptoms,28 cases(25.93%)had depression symptoms,23 cases(21.10%)coexisted with anxiety and depression,and 78cases(71.56%)were negative.There was significant correalation between existence of temperature rhythm with anxiety symptom,depression symptom,coexistence of anxiety and depression(P < 0.05).There was no significant correalation between heart rate rhythm with anxiety symptom,depression symptom coexistence of anxiety and depression(P > 0.05).There was no significant correalation between in blood pressure with anxiety symptom,depression symptom coexistence of anxiety and depression(P >0.05).There was no significant difference in body temperature,heart rate and blood pressure rhythm parameters among different groups of anxiety,depression,coexistence of anxiety and depression(all P > 0.05).(4)The relationship between circadian rhythm parameters of body temperature,heart rate and blood pressure and quality of life 3 months after traumatic brain injury in patients at acute stageThere were 20 cases with PTSD symptoms and 89 cases non-PTSD symptoms.There was statistically significant difference between the PTSD group and the group non-PTSD(P < 0.05).The disappearance heart rate rhythm,body temperature and blood pressure rhythm were statistical significance between PTSD group and non-PTSD group(P < 0.05).The M and A+M rhythm parameters of body temperature and the M rhythm parameters of systolic blood pressure were significantly different between PTSD group and PTSD group(P < 0.05).There were no statistically significant differences in A,A/M,φ of body temperature rhythm parameters,all parameters of heart rate rhythm,and all parameters of diastolic blood pressure rhythm between non-PTSD group and PTSD group(P > 0.05).(5)Correlation between circadian rhythm cosine curve parameters of body temperature,heart rate and blood pressure in TBI patients and quality of life at 3 months after injury:1)Body temperature: there was statistically difference in the total scores of SF-36,BP,GH,VT in groups with or without body temperature rhythm(P < 0.05).The M of body temperature rhythm parameter was significantly related to the total score of quality of life(r =-0.235,P < 0.05).Other parameters of body temperature rhythm such as A,A/M,A + M,φ were not related to the total score of quality of life(P > 0.05).2)Heart rate: there was significant difference in SF of quality of life and the total score of SF-36 in groups of whether the heart rate rhythm disappeared or not(P < 0.05).M,A+M of heart rate rhythm parameters were significantly related to the total score of quality of life(r =-0.231,P < 0.05),(r =-0.162,P < 0.05).Other parameters of heart rate rhythm including A,A / M,φ were not significantly related to the total score of quality of life(P > 0.05).3)Systolic blood pressure: whether systolic blood pressure rhythm disappeared in each dimension and total score of quality of life did not have statistical difference(all P > 0.05).There was no correlation between systolic blood pressure rhythm parameters and total score of quality of life(P > 0.05).4)Diastolic blood pressure: there was no significant difference in each dimension and total score of quality of life(all P > 0.05).There was no significant correlation between systolic blood pressure rhythm parameters and total score of quality of life(P >0.05).(6)Sixty-one cases were able to complete daily activities independently;32cases had mild dysfunction and could complete part of daily activities independently;9cases had moderate dysfunction and needed great help to complete activities of daily living;40 cases had severe dysfunction,and their activities of daily living could not be completed or needed care.Whether body temperature and heart rate rhythm disappeared in the prognosis of neurological function was statistically different(P < 0.05).There was no significant difference in the prognosis of neurological function(P > 0.05).The rhythm parameters including A,M,A / M and A + M of body temperature were significantly different between the group with and without activity disorder(P < 0.05).The rhythm parameters M and A + M of heart rate were significantly different between the activity free group and the activity impaired group(P < 0.05).There was no significant difference in the parameters of blood pressure and rhythm between the groups with and without activity disorder(P > 0.05).5 Analysis of predictors of neurological function,psychological state,quality of life and ability of daily living at 3 months after injury(1)Neurological prognosis: Univariate results showed that there were significant differences between the group with good neurological prognosis and the group with poor prognosis in length of hospital stay,severity of injury,pupil state,state of consciousness,extent of injury,whether to operate,whether to have complications during hospitalization,whether to live in ICU,whether to have deterministic artificial airway and whether to use ventilator(P < 0.05).Multivariate analysis showed that the risk factors of prognostic outcome were GCS score(moderate)(β= 1.360,P=0.042);severe(β= 2.374,P = 0.000),deterministic artificial airway(β= 1.223,P=0.023).(2)Health related quality of life: Univariate analysis showed that age,length of hospital stay,severity of injury,pupil ICU,uncertain artificial airway and use of ventilator were related to the score of quality of life(P < 0.05).Multivariate analysis showed that the presence or absence of deterministic artificial airway and age were the influencing factors of quality of life score(P < 0.05).(3)Ability of daily living: The results of univariate analysis showed that age,length of hospital stay,severity of injury,pupil state,state of consciousness,scope of injury,whether to operate,whether to have complications during hospitalization,whether to live in ICU,whether to have deterministic artificial airway There was significant difference between using ventilator and not(P < 0.05).The risk factors of ADL were living in ICU(β=-4.158,P = 0.029),deterministic artificial airway(β=5.480,P = 0.034),GCS score(β= 2.835,P=0.001).(4)Anxiety: Univariate analysis showed that there was no significant difference in general data and clinical data between non anxiety symptom group and anxiety symptom group(P > 0.05).(5)Depression: The results of univariate analysis showed that there were significant differences in age,causes of injury and payment methods between the nondepressed group and the depressed group(P < 0.05).The results of multivariate analysis showed that the risk factors of depressive symptoms were the way of payment(β= 1.221,P=0.008).(6)Post-traumatic stress disorder: Univariate analysis showed that there was significant difference in the causes of injury between non-PTSD group and PTSD group(P < 0.05).Multivariate analysis showed that fall was a risk factor for PTSD(β= 1.662,P=0.004).Conclusion:(1)TBI patients show a disorder of circadian rhythm of body temperature,heart rate and blood pressure in the acute stage,which is manifested as the disappearance of parts of circadian rhythm.The circadian rhythm of heart rate disappeared in patients with mild TBI;the circadian rhythms of heart rate and diastolic blood pressure disappeared in patients with moderate TBI;and the circadian rhythm of heart rate,systolic blood pressure and diastolic blood pressure disappeared in patients with severe craniocerebral trauma.(2)Circadian rhythm of body temperature and heart rate in patients with TBI can predict the prognosis of neurological function.The circadian rhythm parameters of body temperature and heart rate in patients with TBI can be used as predictors of neurological prognosis,but the circadian rhythm changes of blood pressure and its parameters have no relationship with the prognosis,so they can not be used as predictors of prognosis.(3)The more serious the injury is in patients with TBI,the worse the prognosis of neurological function is in patients with deterministic artificial airway.The quality of life of patients with deterministic artificial airway and older age will be lower.The more serious the injury,the worse the prognosis of ADL.Paying at one’s own expense will make patients more prone to depressive symptoms.Compared with traffic accidents,falls are more likely to lead to post-traumatic stress disorder syndrome. |
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