The Clinical Research Of Noninvasive Brain Edema Dynamic Moniting In Patients With Neurological Intensive

Objectives To evaluate the condition and prognosis in patients with neurological intensive by non-invasive dynamic monitoring of cerebral edema,and provide theoretical basis for judging severity of brain edema and guiding treatment in clinical timely,and to further explore the dynamic evolution process of brain edema and influencing factors of prognosis in patients with the unilateral hemisphere massive cerebral infraction and cerebral hemorrhage.Methods Selection of patients with the unilateral hemisphere massive cerebral infraction and cerebral hemorrhage in neurological intensive care unit(NICU)of kailuan general hospital from January 2016 to December 2016,monitoring their agitating coefficient of bilateral cerebral hemisphere brain during the onset of 1,3,5,7,14 days,to discuss the dynamic evolution process of brain edema and influencing factors of prognosis in patients with massive cerebral infraction and cerebral hemorrhage.Monitoring the volume of hematoma and brain edema under the head CT during the onset of 1,3,5,7,14 days,to explore the indicating significance of the noninvasive dynamic monitoring to the brain edema;Selection of patients in neurological intensive care unit(NICU)of kailuan general hospital who received lumbar puncture therapy,monitoring the pressrue of lumbar puncture after the noninvasive brain edema monitoring,and monitoring and recording the pulsatility index and resistance index through TCD,observation of the relation between the pressrue of lumbar puncture and PI,RI and between agitating coefficient,to explore the indicating significance of the noninvasive dynamic monitoring to Intracranial pressure;In addition,following up the patients with the unilateral hemisphere massive cerebral infraction and cerebral hemorrhage,recording their MRS onset of 1 and 3 month,to expore the influence factors of the prognosis in the near future and the long-term.Results1 24 patients with the unilateral hemisphere massive cerebral infarction?28 patients with the unilateral hemisphere cerebral hemorrhage and 49 patients received lumbar puncture that totally 58 times were selected ioto group.2 The agitating coefficient of the massive cerebral infraction patients was gradually rise in 14 days,peak at the onset of 7 days,persists for more than 14 days,the agitating coefficien of the contralateral hemisphere was the same as the trend of the lateral,the variance analysis of the agitating coefficien in both the two sides showed that each group differences between groups was statistically significant(F=12.87 P=0.00;F=5.40 P=0.00).Comparison the agitating coefficien in 3,5,7,14 days of the one side were higher than the contralateral side(P < 0.05).3 The agitating coefficient of the unilateral hemisphere cerebral hemorrhage patients was gradually rise in 14 days,the variance analysis of the agitating coefficien in both the two sides showed that each group differences between groups was statistically significant(F=7.63 P=0.00;F=3.18 P=0.02);Comparison the agitating coefficien in 3,5,7,14 days of the one side were higher than the contralateral side(P < 0.05);4 The agitating coefficient of 28 patients with cerebral hemorrhage and cerebral edema volume ? hematoma volume was positively correlation(r=0.63 P=0.00;r=0.25P=0.01);5 There were no correlation between the agitating coefficient of 52 patients with the unilateral hemisphere cerebral infraction and cerebral hemorrhage and NIHSS?GCS in corresponding time by the day of 1 and 14 days(P > 0.05);There were no correlationbetween onset of 7 day of the agitating coefficient and corresponding NIHSS(P >0.05),while negatively related with GCS score(r=0.28 P=0.046);There were no correlation between 52 patienrs of the agitating coefficient and the APACHE ? score(r=0.17P=0.22);6 There were postively correlated between the agitating coefficient and the lumbar puncture pressure in 58 times lumbar puncture(r=0.27 P=0.04);the agitating coefficient and the corresponding side artery PI?RI were no correlaton(P<0.05);7 Logistic regression analysis showed that the higher agitating coefficient onset of 5day and the higher NIHSS score affecting the prognosis in the near future,and the higher NIHSS score that admission to hospital affecting the long-term prognosis in patients with the cerebral infraction and cerebral hemorrhage.Conclusions1 The brain edema in patients with the unilateral hemisphere cerebral infraction and cerebral hemorrhage showed regular changes,and the contralateral side exist brain edema at the same time.2 Noninvasive brain edema dynamic monitoring can only hints intracaanial pressure indirectly,providing reference for clinical to some extent.3 The severity of brain edema is the important factor affecting the recent prognosis in patients with storke,at the same time extensive damage to nerve function was also an important risk factor.4 Noninvasive brain edema dynamic monitoring can be relatively accurately reflect the degree of cerebral edema in patients with neurological intensive,can be used as an important supplement of the CT/MRI.