Application Of NT-proBNP In Acute Craniocerebral Injury Induced By Cerebral Cardiac Syndrome

Application of NT-proBNP in acute craniocerebral injury induced by cerebral cardiac syndromePartⅠRelationship of NT-proBNP, EKG and myocardial injury markersObjective:The experimental study of acute craniocerebral injury patients with brain heart syndrome, NT-proBNP and EKG, myocardial enzyme spectrum, and NT-proBNP and CK-MB, troponin I and specific markers of myocardial injury in relationship.Method:Collected in our hospital intensive care unit (ICU) from January 2010 to December 2010 were in patients with acute craniocerebral injury in 127 cases, electrolyte disturbances, combined with thoracic injury and previous heart disease excluded. Craniocerebral trauma by skull CT and MRI confirmed that, according to the imaging findings will brain injury by site is divided into the subdural, epidural, cerebral contusion and laceration (diffuse axonal injury), intraventricular hemorrhage, brain injury, subarachnoid hemorrhage (SAH). All patients were on admission, 24h,72h immediately,7 days an electrocardiogram, and at the same time for venous blood sampling for serum N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin I and myocardial enzyme spectrum, including aspartate aminotransferase (AST), lactate dehydrogenase (LDH), alpha hydroxybutyrate dehydrogenase (HBDH), creatine phosphokinase (CPK) and MB isoenzyme of creatine kinase (CK-MB)Result:(1) In 127 cases of patients with acute craniocerebral injury, 95 cases of electrocardiographic abnormalities, cerebral cardiac syndrome incidence rate of 74.8%, ventricle and brain stem injury with abnormal rate of EKG was 100%; the overall mortality rate was 26.8%, cerebral cardiac syndrome a case fatality rate of 35.8%; (2) Cerebral cardiac syndrome cases, have different degrees of abnormal NT-proBNP, Q-T and ST-T wave abnormality rate is low (25%); sinus tachycardia (bradycardia) heartbeat abnormal rate of 40%-50%; and atrial, ventricular arrhythmias and conduction block of the abnormal rate of 60%-80%; (3) Acute craniocerebral injury induced by cerebral cardiac syndrome within 24 hours, myocardial enzymes have different degrees of elevation, which increased CK-MB is most common, especially brain contusion and laceration, intraventricular hemorrhage, brain stem injury cases increased significantly (P<0.05); (4) Acute craniocerebral injury induced by cerebral cardiac syndrome, myocardial damage marker cTnI, CK-MB increased, and NT-proBNP increased correlated (P<0.05),34 death cases, the abnormal rate of NT-proBNP was above 80%, duration of greater than 72h.Conclusion:(1) Acute craniocerebral injury complicated with brain heart syndrome is easy. The higher the level of NT-proBNP, EKG and myocardial enzyme spectrum of abnormal rate is higher, which was positively related to. (2) In the different sites of injury, ventricle, brain stem injuries are more likely to result in cerebral cardiac syndrome occurs; in different types of arrhythmia, easily lead to atrial ventricular abnormal pulsation, caused by ventricular tension change types of arrhythmia, the abnormal rate of NT-proBNP is higher. (3) NT-proBNP in patients with cerebral cardiac syndrome has a high sensitivity and specificity, and CK-MB, troponin I, can be used as specific markers of myocardial damage. PartⅡEffect of NT-proBNP in acute craniocerebral injury induced by cerebral cardiac syndrome during operation periodObjective:The experimental study of acute craniocerebral injury induced by cerebral cardiac syndrome around the operation period of the basic situation, relationships of NT-proBNP, EKG and myocardial enzymes, and the Change trend of NT-proBNP with different GCS score.Method:Collected ICU from January to December 2010 were in patients with acute craniocerebral i njury in 95 cases, electrolyte disturbances, combined with thoracic injury and previous heart disease excluded. According to the type of electrocardiogram and clinical manifestations, diagnosis of cerebral cardiac syndrome. Craniocerebral trauma by skull CT and MRI confirmed that, according to the GCS (Glasgow coma scale) is divided into 3-5,6-8,9-12,12～15 are divided into four groups, according to the imaging findings will brain injury by site is divided into the six groups. Operation cases were at the time of admission, admission to hospital immediately,24h,72h,7 days an electrocardiogram, and at the same time for venous blood sampling for serum NT-proBNP, cardiac troponinⅠand myocardial enzyme spectrum, including aspartate AST, LDH, HBDH, CPK and CK-MB, after 24 hours of reexamination of head CT. An operation case also line the biochemical screening, to contrast.Result:(1) Different sites of injury before and after operation mortality was not significantly different (P>0.05), and intraventricular hemorrhage and brain stem injury cases, the mortality rate is higher than that of other sites of injury cases (P<0.05); (2) In the group of patients before and after operation display, ECG and NT-proBNP abnormalities improved significantly (P<0.05); and the non operation the improvement is not clear in treatment group (P>0.05); comparison between two groups,72h postoperative ECG and abnormal rate of NT-proBNP was significantly lower than the non operation group (P<0.05); (3) Cases in this group show, before the operation and two controls, myocardial injury markers such as myocardial enzyme spectrum, NT-proBNP had no significant difference (P>0.05); and postoperative myocardial injury characteristic markers of CK-MB and NT-proBNP were significantly lower (P<0.05); (4) Different scores of GCS group, the NT-proBNP variations, the lower the score, the higher the level of NT-proBNP; operation group compared with the control group, the NT-proBNP level after operation operation group were significantly lower than before; all were compared between groups, special severe craniocerebral injury (GCS<5) cases of NT-proBNP levels (P<0.05).Conclusion:(1) Operation of acute craniocerebral injury induced by cerebral cardiac syndrome on the prognosis of patients with no significant influence, but the injury involving the ventricle and brain stem, caused by brain heart syndrome in patients with poor prognosis. (2) Operation intervention can not change the prognosis, but can make the NT-proBNP peak fronting, improve patients with myocardial damage, reduce heart serious complications which resulting from. (3) NT-proBNP and GCS score were correlated, lower GCS scores, higher NT-proBNP levels, and suggesting that NT-proBNP can be used as the assessment of illness severity index. Part III Validation of NT-proBNP and APACHE II Score in prognosis assessment of patients in acute craniocerebral brain injury induced by cerebral cardiac syndromeObjective:All ICU admissions were tested on plasma NT-proBNP level and evaluated by APACHEⅡ(acute physiology and chronic health evaluationⅡ) scoring system in order to investigate the validity of both NT-proBNP and APACHE II in prognosis assessment of patients in acute craniocerebral brain injury induced by cerebral cardiac syndrome.Method:Data were collected prospectively on 95 ICU admissions with cerebral-cardiac syndrome caused by acute craniocerebral injury from January 2010 to December 2010. The APACHE II score was calculated and plasma NT-proBNP level was measured within the first 24 hours after admission. Validity of both NT-proBNP and APACHEII score was evaluated by analyzing the correlation among a few prognosis prediction parameters, i. e.the survival time and length of hospitalization.Result:(1) In 95 patients with APACHEII score 13 to 39 points, an average of (24.4±7.3), plasma NT-proBNP concentrations for an average of (1165.15±1120.76)pg/ml. Among the 61 cases of survivor APACHEII score (22.3±6.8), concentration of plasma NT-proBNP (861.6±503.4) pg/ml,34 cases of death of APACHE II score (29.4±5.9), concentration of plasma NT-proBNP (1907.2±959.2) pg/ml. Death group APACHE II score value and plasma NT-proBNP concentrations were significantly higher in the survival group, the difference was significant (P<0.01); (2) In 95 patients by APACHEII score were divided into three groups:less than 15 are divided into groups a,16-30 is divided into groups of two, more than 30 are divided into groups of three, three between group NT-proBNP level has significant difference, P were less than 0.05, can be found in critically ill patients with NT-proBNP level with APACHE II score level rising. The multiple samples the chi-square test, three groups of mortality rate in patients with significant difference, with the APACHE II score increased (x2= 14.759, P=0.01), respectively 0%,20% and 66.7%, the overall mortality rate 35.8%; (3) In 95 patients by NT-proBNP levels were divided into four groups:< 125 group,125-450,450-1250 group and 1250 group, four group of APACHEⅡscore level has significant difference (F=15.603, P=0), can be found in critically ill patients with APACHE II score values with elevated NT-proBNP levels and elevated. Four groups of patients the fatality rate difference was also significant, with elevated NT-proBNP levels and elevated (x2=13.392, P=0.004), the overall mortality rate 35.8%. Among the four groups in length of hospitalization, the difference was statistically significant (P=0.047), can be found in critically ill patients length of hospitalization with the NT-proBNP level increased.Conclusion:NT-proBNP and APACHE II score for ICU in acute craniocerebral injury induced by cerebral cardiac syndrome the prognosis of the patients, such as mortality, hospitalization time and so on, can be used as independent factors:the combination of the two is more useful in critically ill patient monitoring and treatment.