| Objective 1.To explore the reference ranges and influential factors of disturbance coefficient(DC)in children without craniocerebral injury at different ages.2.To explore the clinical value of DC in judgement of brain edema,monitoring of intracranial pressure,evaluation of illness condition and elimination of prognosis in children after operation of severe craniocerebral trauma.Methods This was a prospective study.Section I:1.Two hundred children without craniocerebral injury admitted to the Department of Orthopaedics in Children's Hospital Affiliated to Chongqing Medical University from May 2018 to October 2019 were enrolled in this prospective study.The children were divided into four groups according to age,i.e.0~1 year,>1~3 years,>3~5 years and >5~16 years,each of which included 50 children.2.Each child had DC measured twice with the non-invasive dynamic cerebral edema monitor,and the average value was used as the terminal DC value.Each measurement lasted 15 minutes,12 hours apart.3.The difference of DC values among the four groups and between different genders were compared with ANOVA test and nonparametric test.And the Loess local weighted nonparametric regression analysis was used to explore the change of DC according to the increase of age,weight and head circumference(HC).Section II:1.From May 2018 to October 2019,35 children aged 5 to 16 years old after operation of severe craniocerebral trauma in the Department of Critical Care Medicine of Children's Hospital of Chongqing Medical University were included in the injured group.At the same time,35 children aged 5 to 16 years old in the Department of Orthopaedics of Children's Hospital of Chongqing Medical University were included in the control group.2.DC values were obtained for all study participants using the non-invasive brain edema dynamic monitor(BORN-BE-IV,Chongqing Bornfuke Medical Equipment Co.,Ltd.).For participants in the control group,the DC was determined during the preoperative examination conducted after hospital admission.For all 35 patients in the injury group,DC values were obtained at 24,48,72,96,120,and 144 hours post-operation.Invasive monitoring of intracranial pressure(ICP)was also applied in 16 patients in the injury group,and the ICP was recorded every 2 hours from 24–48 hours after implantation of an Invasive Intracranial Pressure Monitor(Johnson & Johnson Codman Company)during the operation.For the 16 patients in the injury group who alsoreceived invasive ICP monitoring,the DC was measured at the same time points as ICP(every 2 hours from 24–48 hours post-operation).For all 35 patients in the injury group,head computed tomography(CT)results were obtained at 24 hours after operation,the Glasgow coma score(GCS)at 24 hours after operation and the Glasgow outcome score(GOS)at 3 months after operation were determined.3.Comparing if there was statistical significance in the mean of DC between the injured group and the control group.Exploring the relationship between DC and ICP,GCS,and GOS,as well as the relationship between DC and head CT results in injured group.Drawing the receiver operating curve(ROC)of DC to find the best diagnostic critical value for DC to judge brain edema.We also described the changes of DC in 6 days after operation in the injured group.Results Section I:1.The reference values of DC for children of 0~1year,>1~3 years,>3~5 years,and >5~16 years were 60.1±13.6,91.7±18.0,112.1±18.2,134.9±17.5,respectively(F= 175.690,P < 0.001).2.There was no statistical significance in DC between male and female children either in the whole or in each separate age groups(102.7(81.0,125.3)vs.102.1(67.8,122.7),Z=-0.739,P=0.460;59.0(52.0,68.3)vs.57.3(53.0,65.0),Z=-0.243,P=0.808;88.2(81.5,104.8)vs.94.9(70.5,105.0),Z=-0.776,P=0.437;117.0(99.2,120.1)vs.112.7(101.5,122.6),Z=-0.170,P=0.865;137.2(123.3,143.0)vs.142.3(122.8,159.7),Z=-1.279,P=0.201).3.Whenthe child's age was younger than 5.0 years old,weight was less than 18.0 kg or HC was less than 51.0 cm,the increase in DC was positively related to the increase of age,weight or HC.However,when the age,weight and HC were over the above values,the DC did not show obvious increase,but approaching to stable values of 135.0,130.0,and 130.0,respectively.Section II:1.There was no statistical difference in age,sex,body weight and HC between the injured group and the control group(P > 0.05).But there was statistical different that the mean DC of the injured group was lower than the control group(98.9±21.1 vs.134.7±18.5,t=-7.542,P<0.001).2.In the injured group,DC was negatively correlated with the value of invasive ICP(r=-0.262,P<0.001),and positively correlated with the value of GCS(r=0.543,P=0.001)and GOS(r=0.368,P=0.035).The higher of the ICP,the more serious of the degree of consciousness disturbance or the worse of the prognosis,the lower of the DC.3.The ROC curve showed that the optimal diagnostic cut-off value for DC to judge brain edema was 117.0,with a sensitivity of 79.1%,specificity of 88.9%,and area under the curve of 0.885.4.The DC in the injury group showed a downward trend during the first 3 days post-operation followed by an upward trend to day 5,with the lowest values observed on day 3.Conclusion 1.For children without craniocerebral injury,the reference values of DC are obviously different at different ages.DC ispositively related to age,weight and HC,but becomes stable when children are older than 5 years old.2.For children with severe craniocerebral injury,DC monitoring showed clinical value for judging brain edema,monitoring ICP,evaluating the extent of injury,and predicting prognosis with the advantages of being non-invasive,safe,continuous,and convenient for bedside use. |
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