Effects of target-oriented therapy under direction of dynamic monitoring of regional cerebral oxygen saturation on patients severe traumatic brain injury

doi:10.3877/cma.j.issn.2095-9141.2022.05.007

Abstract

Abstract:

Objective

To valuate the clinical application of target directed therapy of monitoring regional cerebral oxygen saturation (rScO₂) in severe traumatic brain injury (sTBI).

Methods

A total of 60 patients with sTBI who were treated in the neurosurgical intensive care unit (NSICU) of Inner Mongolia People's Hospital from April 2018 to November 2020 were randomly divided into experimental group and control group, with 30 patients in each group. The control group was given traditional neurosurgical intensive care management, and the experimental group was given rScO₂ target monitoring and guidance treatment on the basis of conventional neurosurgical intensive care management. The hospital stay in NSICU, GCS score at discharge, complication rate, mortality after 6 months, modified Rankin scale (mRs) score and GOS score were compared between the two groups.

Results

The GCS score of both groups at discharge were higher than the initial score at admission, and the GCS scores of the experimental group at discharge were higher than those of the control group, but the difference was not statistically significant (P>0.05). The length of stay in NSICU in experimental group was significantly decreased compared with control group (P<0.05). After 6 months of follow-up, both the mRs score and GOS score in the experimental group were significantly better than those in the control group, and the mortality was significantly lower than that in the control group (P<0.05). Kaplan-Meier survival curve analysis showed that the survival time of experimental group was significantly better than that of control group (P<0.05).

Conclusion

The target-directed therapy under the direction of monitoring rScO₂ can effectively shorten the length of stay in NSICU, reduce the fatality rate and improve the prognosis of patients with sTBI.

Key words: Severe traumatic brain injury, Near-infrared spectroscopy, Regional cerebral oxygen saturation, Prognosis

Zhong Wang, Ruijian Zhang, Zhitong Han, Junqing Wang, Rile Wu, Weiping Zhao, Xiaojun Zhang, Jingang Bao, Shumin Yang, Weiran Yang, Zhilong Zhang. Effects of target-oriented therapy under direction of dynamic monitoring of regional cerebral oxygen saturation on patients severe traumatic brain injury[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2022, 08(05): 293-297.

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References 16

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项目		对照组（n=30）	试验组（n=30）	t/χ²值	P值
性别（男/女）		20/10	21/9	0.697	0.404
年龄（岁，±s）		52.3±14.3	51.2±12.4	0.343	0.733
初始GCS评分（分，±s）		4.8±2.3	5.2±2.1	0.761	0.450
损伤原因[例（%）]				0.174	0.917
	车祸伤	18（60.0）	17（56.7）
	坠落伤	8（26.7）	9（30.0）
	打击伤	4（13.3）	4（13.3）
损伤类型[例（%）]
	硬膜外血肿	6（20.0）	5（16.7）	0.229	0.632
	硬膜下血肿	4（13.3）	5（16.7）	0.008	0.927
	脑挫裂伤合并颅内血肿	20（66.7）	20（66.7）	0.034	0.854
脑疝[例（%）]		10（33.3）	11（36.7）	0.015	0.902
去骨瓣减压术[例（%）]		11（36.7）	11（36.7）	0.001	0.977

项目		对照组（n=30）	试验组（n=30）	t/χ²值	P值
性别（男/女）		20/10	21/9	0.697	0.404
年龄（岁，±s）		52.3±14.3	51.2±12.4	0.343	0.733
初始GCS评分（分，±s）		4.8±2.3	5.2±2.1	0.761	0.450
损伤原因[例（%）]				0.174	0.917
	车祸伤	18（60.0）	17（56.7）
	坠落伤	8（26.7）	9（30.0）
	打击伤	4（13.3）	4（13.3）
损伤类型[例（%）]
	硬膜外血肿	6（20.0）	5（16.7）	0.229	0.632
	硬膜下血肿	4（13.3）	5（16.7）	0.008	0.927
	脑挫裂伤合并颅内血肿	20（66.7）	20（66.7）	0.034	0.854
脑疝[例（%）]		10（33.3）	11（36.7）	0.015	0.902
去骨瓣减压术[例（%）]		11（36.7）	11（36.7）	0.001	0.977

项目		试验组（n=30）	对照组（n=30）	t/χ²值	P值
GCS评分（分，±s）
	初始	4.8±2.3	5.2±2.1	0.761	0.450
	出院时	5.8±2.2	5.0±2.3	1.378	0.174
NSICU住院时间（d，±s）		10.3±4.6	13.1±4.8	2.307	0.025
并发症[例（%）]
	肺部感染	12（40.0）	13（32.5）	0.069	0.793
	泌尿系感染	8（26.7）	9（30.0）	0.082	0.775
	应激性溃疡消化道出血	7（23.3）	9（30.0）	0.341	0.559
	肝肾功异常	6（20.0）	7（23.3）	0.099	0.754
	电解质紊乱	11（36.7）	12（40.0）	0.071	0.791
死亡率[例（%）]		4（13.3）	11（36.7）	4.356	0.037
6个月后GOS评分（分，±s）		3.9±1.1	3.2±0.8	2.819	0.007
6个月后mRs评分（分，±s）		3.3±0.9	3.8±0.8	2.274	0.027

项目		试验组（n=30）	对照组（n=30）	t/χ²值	P值
GCS评分（分，±s）
	初始	4.8±2.3	5.2±2.1	0.761	0.450
	出院时	5.8±2.2	5.0±2.3	1.378	0.174
NSICU住院时间（d，±s）		10.3±4.6	13.1±4.8	2.307	0.025
并发症[例（%）]
	肺部感染	12（40.0）	13（32.5）	0.069	0.793
	泌尿系感染	8（26.7）	9（30.0）	0.082	0.775
	应激性溃疡消化道出血	7（23.3）	9（30.0）	0.341	0.559
	肝肾功异常	6（20.0）	7（23.3）	0.099	0.754
	电解质紊乱	11（36.7）	12（40.0）	0.071	0.791
死亡率[例（%）]		4（13.3）	11（36.7）	4.356	0.037
6个月后GOS评分（分，±s）		3.9±1.1	3.2±0.8	2.819	0.007
6个月后mRs评分（分，±s）		3.3±0.9	3.8±0.8	2.274	0.027

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