Traumatic brain injury (TBI) is a common lesion in neurosurgery. TBI includes two parts: primary injury and secondary injury caused by factors such as ischemia, with the latter lasting longer and being an important factor affecting patient prognosis. Severe traumatic brain injury (TBI) is one of the main causes of death and disability in patients, and its pathogenesis is complex. In the early stages, brain tissue edema and ischemia/hypoxia often occur, while stress response leads to increased metabolic levels and oxygen consumption. Brain tissue hypoxia is a key means of monitoring the progression of severe traumatic brain injury patients, and monitoring the level of brain tissue oxygen metabolism can serve as a reference for evaluating the condition and efficacy. Guided therapy based on monitoring of regional cerebral oxygen saturation (rScO2) is beneficial for shortening the length of stay in the intensive care unit (ICU) of patients with severe TBI and improving their prognosis.
The aim of this study is to explore the impact of guided therapy based on intracranial pressure monitoring combined with dynamic monitoring of local cerebral oxygen saturation (rScO2) on the prognosis of patients with severe traumatic brain injury.
1. General information:A randomized controlled clinical trial was conducted on 146 patients with severe TBI from August 2020 to August 2022. They were randomly divided into an observation group and a control group, with 73 patients in each group. There were no significant differences in baseline data such as gender, age, cause of injury, and GCS score between the two groups of patients.2. Research methods:The control group received routine treatment, while the observation group monitored ICP and rScO2 on the basis of routine treatment and carried out targeted treatment. Targeted interventions were carried out based on changes in ICP and rScO2. When rScO2 is ≤ 50% or decreases by ≥ 15% from baseline, sputum aspiration should be performed to ensure airway patency. After that, the inhaled oxygen concentration or positive end expiratory pressure should be increased. If the test shows that the patient's hemoglobin level is low, blood transfusion should be given as soon as possible. Other treatment measures are the same as the control group.3. Observation indicators:The main observation indicators include rehabilitation speed, cerebral oxygen metabolism indicators (CERO2, blood lactate levels), inflammatory factors (IL-6, IL-10, TNF - α), and prognosis (GOS score).1. Recovery speed:The observation group had significantly shorter mechanical ventilation time, ICU stay time, and hospitalization time compared to the control group.2. Brain oxygen metabolism indicators:The improvement effect of CERO2 and blood lactate levels in the observation group was significantly better than that in the control group after 7 days of treatment.3. Inflammatory factors:The levels of IL-6, IL-10, and TNF - α significantly decreased in the observation group after 7 days of treatment.4. Prognostic situation：After 6 months of treatment, the good prognosis rate of the observation group with GOS score>3 was significantly higher than that of the control group.
Targeted therapy based on ICP and rScO2 dynamic monitoring can significantly improve the cerebral oxygen metabolism level, reduce inflammatory response, shorten recovery time, and improve prognosis in severe TBI patients, providing important evidence-based medicine for clinical practice.
Dynamic monitoring of ICP and rScO2 can accurately reflect the pathological and physiological changes in early brain tissue of severe TBI patients, and take timely and effective measures to correct cerebral hypoxia and reduce neurological damage.The results of this study are consistent with other related research findings, indicating that guided therapy has significant advantages in improving the prognosis of severe TBI patients.
The application of guided therapy based on dynamic monitoring of local cerebral oxygen saturation (rScO2) has significant advantages in the prognosis of patients with severe traumatic brain injury (TBI). The main advantages of this monitoring method are reflected in the following aspects: Non invasive monitoring:RScO2 is a non-invasive monitoring method. RScO2 utilizes near-infrared spectroscopy technology to dynamically monitor the levels of oxygenated hemoglobin in local brain tissue, in order to evaluate the oxygen supply and consumption status of brain tissue. These methods are safer and more convenient compared to traditional traumatic monitoring methods, reducing patients' pain and infection risk. Dynamic monitoring:These two monitoring methods can reflect real-time pathological and physiological changes in brain tissue, providing timely feedback for clinical doctors to make rapid adjustments and interventions based on monitoring results. For example, when rScO2 decreases, the patient's oxygen intake level can be adjusted or other interventions can be performed to ensure sufficient oxygen supply to brain tissue. Improving prognosis:Research has shown that guided therapy based on rScO2 dynamic monitoring can significantly shorten the mechanical ventilation time, ICU stay, and hospitalization time of critically ill TBI patients. This treatment method not only helps accelerate the recovery of patients, but also improves the overall efficiency of treatment, reduces hospitalization costs, and consumes medical resources. Optimization of cerebral oxygen metabolism:By dynamically monitoring brain oxygen metabolism indicators, the oxygen supply and consumption status of brain tissue can be better evaluated and improved. The research results showed that patients who received targeted therapy based on ICP and rScO2 monitoring had significantly increased brain oxygenation levels and significantly decreased blood lactate levels, indicating a significant improvement in brain tissue oxygen metabolism, thereby reducingSecondary damage caused by hypoxia. Reduce inflammatory response:Severe TBI patients often have significant inflammatory reactions, leading to secondary brain damage. By dynamically monitoring and adjusting the treatment plan accordingly, the levels of serum inflammatory factors (such as IL-6 and TNF - α) can be effectively reduced, and the levels of anti-inflammatory factors (such as IL-10) can be increased, thereby reducing the damage of inflammatory response to brain tissue and further improving the prognosis of patients. In summary, the Bolian Zhongke MOC series cerebral oxygen tissue saturation monitor can provide a targeted treatment method based on rScO2 dynamic monitoring. Through non-invasive, dynamic, and real-time monitoring methods, it provides clinical doctors with more accurate disease assessment and treatment adjustment basis, effectively improving the cerebral oxygen metabolism and inflammatory response of severe TBI patients, significantly improving the recovery speed and prognosis quality of patients.
