Clinical Research Based On Multi-modal Monitoring In Severe Traumatic Brain Injury

Traumatic brain injury?TBI?is an injury to the head caused by external force,resulting in skull fracture,intracranial hematoma,cerebral contusion and laceration and axonal injury.It has been recognized that TBI is one of the leading causes of death and disability worldwide,especially severe brain injury?sTBI?.Despite the rapid development of science and technology in the past 30 years,there is still no revolutionary breakthrough in the treatment of sTBI.The mortality rate of sTBI patients can be as high as 35%.It is a public health event that needs to be improved urgently for the entire world.At present,the main focus of the treatment of craniocerebral injury is to reduce the progress of secondary brain injury.The best concept for the treatment of sTBI today is Multi-modal Monitoring?MMM?,which aims to reflect brain cell injury and Changes in the physiological parameters of death to detect secondary brain damage early,and integrate these monitored information into clinical decision-making and early goal-oriented treatment,thereby helping to prevent and treat secondary brain damage before irreversible brain damage occurs Brain Injury.MMM can assess the degree of secondary brain injury from multiple angles and levels from intracranial pressure?ICP?,Cerebral Blood Flow?CBF?,cerebral metabolism,brain function,etc.,and quantify the intracranial disorder after sTBI The parameters are used to guide the treatment of the operating room and the intensive care unit to reduce and alleviate the occurrence of secondary brain injury.In summary,through the following two parts,we perform MMM on sTBI patients,and initially explore the clinical significance of MMM after sTBI condition assessment and guide treatment.Part?:Clinical significance of dynamic monitoring of regional cerebral oxygen saturation and intracranial pressure,cerebral perfusion pressure and prognosis after severe traumatic brain injuryObjective:To investigate the dynamic monitoring of Cerebral Tissue Oxygen Saturation?SctO₂?and ICP,Cerebral Perfusion Pressure?CPP?,Glasgow Coma Scale Score?GCS?,post-injury 6st month Glasgow Outcome Score?GOS?of the clinical significance.Methods:Thirty-three patients with severe traumatic brain injury admitted to the neurosurgical and neurosurgical intensive care unit within 24 hours after injury were selected for dynamic monitoring of SctO₂,ICP,and CPP.The evaluation and recording were performed every 6 hours for 7 consecutive days.At the same time,the GCS at admission and the GOS at 6 months after injury were recorded.The results were statistically analyzed.Results:After sTBI,?1?within 7 days of continuous monitoring,the trend of SctO₂ changed:on the third day,the mean value of SctO₂ reached the lowest,and then gradually increased.?2?SctO₂ has statistical significance between ICP,CPP,GCS and GOS?P<0.05?.Among them,SctO₂ was negatively correlated with ICP?P<0.05?,SctO₂ was positively correlated with GCS,CPP,and GOS?P<0.05?;the main injury side had the best correlation between SctO₂ and CPP?r=0.941,P=0.000?,mainly The correlation between SctO₂ and ICP on the injured side is second?r=0.935,P=0.000?,and the correlation between SctO₂ on the injured side and GCS is the worst?r=0.697,P=0.000?;The correlation is better than the contralateral consistency of the injury.Conclusion:Using SctO₂ to monitor sTBI is a clinically feasible and accurate method,which can achieve early recognition of brain pathophysiological changes of sTBI patients,especially changes in cerebral oxygen metabolism.It may recognize some secondary brain injury changes earlier than ICP,thereby guiding treatment within a clinically effective time window and improving prognosis.Part ? Clinical significance of dynamic monitoring of cerebrospinal fluid and serum Lac,NSE and BBB index after s TBIObjective : To investigate the clinical significance of dynamic monitoring of cerebrospinal fluid and serum Lac?NSE and BBB index in the assessment of disease and prognosis after s TBI.Methods : Thirty-two patients with s TBI who underwent neurosurgery at Lanzhou University Second Hospital within 24 hours after injury were randomly monitored.Cerebrospinal fluid and serum were collected at 1,3,and 7 days after injury,and changes in Lac,NSE,and BBB index were monitored.ICP and GCS and GOS after 6 months of injury were divided into poor prognosis group and good prognosis group according to GOS results.The results were statistically analyzed.Results:After s TBI,?1?cerebrospinal fluid and serum Lac,NSE and BBB index were significantly higher than the normal range?P <0.05?;?2?serum Lac and ICP were correlated?P <0.05?,cerebrospinal fluid Lac,cerebrospinal fluid and serum NSE,There was no correlation between BBB index and ICP?P> 0.05?;?3?Cerebrospinal fluid Lac,cerebrospinal fluid and serum NSE,BBB index were correlated with GCS on admission and GOS at 6 months after injury?P <0.05?.Conclusion : After s TBI,CSF and serum Lac,NSE and BBB indexes are basically not related to ICP?except serum Lac?,but are related to GCS at admission and GOS at 6 months after injury?except serum Lac?,of which cerebrospinal fluid Lac can Accurate and reliable prediction of GOS in June after injury.Therefore,after s TBI,dynamic monitoring of cerebrospinal fluid and serum Lac,NSE,and BBB indexes have the potential to assess the condition and predict the prognosis,and have clinical significance.