Cerebral Microdialysis: Perioperative Monitoring and Treatment of Severe Neurosurgical Patient

Autor: Ibrahim Omerhodžić, Kemal Dizdarević, Krešimir Rotim, Edin Hajdarpašić, Maida Nikšić, Enisa Bejtić-Čustović, Emina Selimović, Mirsada Čustović
Jazyk: angličtina
Rok vydání: 2011
Předmět:
Zdroj: Acta clinica Croatica
Volume 50
Issue 1
ISSN: 1333-9451
0353-9466
Popis: The early signs of brain ischemia are key indicators of secondary brain injury and their recognition on time can ultimately save life. Direct recording of cerebral ischemia is possible using the method of cerebral microdialysis (CM). This paper presents results of the five-year experience in applying this method at University Department of Neurosurgery, Sarajevo University Clinical Center in Sarajevo. In this observational prospective clinical study, the treatment and outcome of 51 patients with subarachnoid hemorrhage (SAH) and traumatic intracranial hemorrhage (tICH) undergoing neurosurgery and consequently treated conservatively at Neurosurgical Intensive Care Unit (NICU) were analyzed. All patients were followed up by unified monitoring at NICU and additionally by the CM method. Between December 2006 and September 2010, CM monitoring was performed in 51 patients: 18 patients with SAH and 33 patients with tICH. In all patients, samples were obtained on 367 occasions, yielding a total of 3314 samples for biochemical parameters (mean 64.98 per patient, range 42-114 samples). Positive correlation was found between glucose level and outcome at one-year follow up (when glucose level was lower, the patient Glasgow Outcome Scale (GOS) score was worse). The correlation coefficient for glycerol was negative (r=-0.81), and so was for the lactate/pyruvate ratio. There was a significant difference in patient outcome in favor of the group of patients monitored by use of CM in terms of poor and good outcome graded according to GOS score 12 months after the injury compared with the group of patients not monitored with CM (P
Rani znaci ishemije mozga su ključni pokazatelji sekundarnih moždanih oštećenja i njihovo prepoznavanje na vrijeme može u konačnici spasiti život. Izravna registracija moždane ishemije moguća je metodom cerebralne mikrodijalize (CM). U radu su prikazani rezultati petogodišnjeg iskustva u primjeni ove metode na Klinici za neurokirurgiju Kliničkog centra Univerziteta u Sarajevu. U prospektivnoj opservacijskoj kliničkoj studiji pratilo se liječenje i ishod u 51 bolesnika sa subarahnoidnim krvarenjem (SAH) i traumatskim intrakranijskim krvarenjem (tICH) koji su bili podvrgnuti neurokirurškoj operaciji, a potom konzervativno liječeni u Neurokirurškoj jedinici intenzivnog liječenja (NICU). Kod svih bolesnika je provedeno standardno praćenje u NICU i dodatno su praćeni metodom CM. U razdoblju od prosinca 2006. do rujna 2010. praćenje pomoću CM provedeno je u 51 bolesnika: 18 bolesnika sa SAH i 33 bolesnika s tICH. U svih bolesnika uzorci su uzeti 367 puta, ukupno 3314 uzoraka biokemijskih parametara (prosječno 64,98 po bolesniku, raspon 42-114). Nađena je pozitivna korelacija između razine glukoze i ishoda u bolesnika nakon godinu dana praćenja; kada je razina glukoze bila niža, zbir GOS (Glasgow Outcome Scale) bolesnika bio je lošiji. Za glicerol je koeficijent korelacije bio negativan (r = – 0,81). Negativna korelacija zabilježena je također za omjer laktat/piruvat. Postojala je značajna razlika u ishodu bolesnika u korist skupine bolesnika koji su praćeni pomoću CM u smislu lošeg i dobrog ishoda, prema zbiru GOS, 12 mjeseci nakon ozljede, u usporedbi s rezultatima bolesnika koji nisu praćeni pomoću CM (P
Databáze: OpenAIRE
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