[Application of analgesia and sedation under BIS monitoring combined with hydraulic coupling intracranial pressure monitoring in severe craniocerebral injury].

OBJECTIVE: To investigate the clinical value of analgesia and sedation under bispectral index (BIS) monitoring combined with hydraulic coupled intracranial pressure (ICP) monitoring in severe craniocerebral injury (sTBI). METHODS: (1) A prospective self-controlled parallel control study was conducted. A total of 32 patients with sTBI after craniotomy admitted to the intensive care unit (ICU) of the First People's Hospital of Huzhou from December 2020 to July 2021 were selected as the research objects. ICP was monitored by Codman monitoring system and hydraulically coupled monitoring system, and the difference and correlation between them were compared. (2) A prospective randomized controlled study was conducted. A total of 108 sTBI patients admitted to the ICU of the First People's Hospital of Huzhou from August 2021 to August 2022 were selected patients were divided into 3 groups according to the random number table method. All patients were given routine treatment after brain surgery. On this basis, the ICP values of the patients in group A (35 cases) were monitored by Codman monitoring system, the ICP values of the patients in group B (40 cases) were monitored by hydraulic coupling monitoring system, and the ICP values of the patients in group C (33 cases) were monitored combined with hydraulic coupling monitoring system, and the analgesia and sedation were guided by BIS. The ICP after treatment, cerebrospinal fluid drainage time, ICP monitoring time, ICU stay time, complications and Glasgow outcome score (GOS) at 6 months after surgery were compared among the 3 groups. In addition, patients in group B and group C were further grouped according to the waveforms. If P1 = P2 wave or P2 and P3 wave were low, they were classified as compensatory group. If the round wave or P2 > P1 wave was defined as decompensated group, the GOS scores of the two groups at 6 months after operation were compared. RESULTS: (1) There was no significant difference in ICP values measured by Codman monitoring system and hydraulic coupling monitoring system in the same patient (mmHg: 11.94±1.76 vs. 11.88±1.90, t = 0.150, P = 0.882; 1 mmHg≈0.133 kPa). Blan-altman analysis showed that the 95% consistency limit (95%LoA) of ICP values measured by the two methods was -4.55 to 4.68 mmHg, and all points fell within 95%LoA, indicating that the two methods had a good correlation. (2) There were no significant differences in cerebrospinal fluid drainage time, ICP monitoring time, ICU stay time, and incidence of complications such as intracranial infection, intracranial rebleeding, traumatic hydrocephalus, cerebrospinal fluid leakage, and accidental extubation among the 3 groups of sTBI patients (P > 0.05 or P > 0.017). The ICP value of group C after treatment was significantly lower than that of group A and group B (mmHg: 20.94±2.37 vs. 25.86±3.15, 26.40±3.09, all P < 0.05), the incidence of pulmonary infection (9.1% vs. 45.7%, 42.5%), seizure (3.0% vs. 31.4%, 30.0%), reoperation (3.0% vs. 31.4%, 40.0%), and poor prognosis 6 months after operation (33.3% vs. 65.7%, 65.0%) were significantly lower than those in group A and group B (all P < 0.017). According to the hydraulic coupling waveform, GOS scores of 35 patients in the compensated group were significantly higher than those of 38 patients in the decompensated group 6 months after operation (4.03±1.18 vs. 2.39±1.50, t = 5.153, P < 0.001). CONCLUSIONS: The hydraulic coupled intracranial pressure monitoring system has good accuracy and consistency in measuring ICP value, and it can better display ICP waveform changes than the traditional ICP monitoring method, and has better prediction value for prognosis evaluation, which can replace Codman monitoring to accurately guide clinical work. In addition, analgesia and sedation under BIS monitoring combined with hydraulic coupled ICP monitoring can effectively reduce ICP, reduce the incidence of complications, and improve the prognosis, which has high clinical application value.

[Predictive value of magnetic resonance spectroscopy combined with diffusion weighted imaging in patients with secondary brain insult after spontaneous intra-cerebral hemorrhage].

OBJECTIVE: To investigate the correlations between the changes of N-acetylaspartate/creatine (NAA/Cr) detected by magnetic resonance spectroscopy (MRS), and of the relative apparent diffusion coefficient (rADC) detected by diffusion weighted imaging (DWI) and the occurrence and outcome of secondary brain injury (SBI) in patients with spontaneous intra-cerebral hemorrhage (SICH). METHODS: One hundred and eight SICH patients diagnosed by CT from January 2014 to December 2019 in the First People's Hospital of Huzhou were selected as the research objects. MRS and DWI examinations were performed on day 2 after admission. The body temperature, blood pressure, blood glucose, blood sodium, arterial oxygen partial pressure (PaO2) and other indexes were continuously monitored. The patients were divided into two groups: SBI group (46 cases) and control group (62 cases) according to whether there were secondary brain injury factors (SBIF). The differences in NAA/Cr and rADC of the edema area and Glasgow outcome score (GOS) after 6 months were compared between the two groups; multivariate Logistic regression analysis was used to analyze the risk factors of SBI. RESULTS: The NAA/Cr and rADC of perihematoma edema area and GOS after 6 months in SBI group were significantly lower than those in control group [NAA/Cr: 1.64±0.35 vs. 1.87±0.41, rADC: 2.57±0.39 vs. 2.75±0.45, GOS after 6 months (points): 3.47±0.59 vs. 3.76±0.65], with significant differences (all P < 0.05). Logistic regression analysis showed that NAA/Cr and rADC were the risk factors for the occurrence of SBI [odds ratio (OR) values were 0.172, 0.343, 95% confidence intervals (95%CI) were 0.048-0.609 and 0.118-0.996, respectively, both P < 0.05]. CONCLUSIONS: MRS combined with DWI has a certain value in predicting SBI after SICH. SBI can aggravate brain injury and affect the prognosis of patients. SBI should be actively prevented and intervention, carried out.

Angiopoietin-1 and Angiopoietin-2 Expression Imbalance Influence in Early Period After Subarachnoid Hemorrhage.

PURPOSE: Microvascular endothelial integrity is important for maintaining the blood-brain barrier (BBB). However, subarachnoid hemorrhage (SAH) disrupts this integrity, making the BBB dysfunctional-an important pathophysiological change after SAH. Angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) regulate microvascular permeability by balancing each other's expression. METHODS: This study investigated the dynamics of Ang-1 and Ang-2 expression after SAH and the protective effect of Ang-1 on BBB functioning using an endovascular puncture model of rat SAH. The Ang-1 and Ang-2 expression in brain tissue was determined by immunohistochemistry. In addition, Western blotting was used to estimate Ang-1 and Ang-2 concentration and to compare them at 6-72 hours post-SAH cortex and hippocampus. Evans blue viability assay was used to evaluate BBB permeability, and neurological testing was implemented to evaluate neurological impairment during SAH. RESULTS: It was found that following SAH, Ang-1 expression decreases and Ang-2 expression increases in the cortex, hippocampus, and microvessels. The Ang-1/Ang-2 ratio decreased as quickly as 6 hours after SAH and reached its lowest 1 day after SAH. Finally, it was found that exogenous Ang-1 reduces SAH-associated BBB leakage and improves neurological function in post-SAH rats. CONCLUSIONS: Our findings suggest that the equilibrium between Ang-1 and Ang-2 is broken in a period shortly after SAH, and the treatment of exogenous Ang-1 injection alleviates neurological dysfunctions through decreasing BBB destruction.