PREDICTING DELAYED CEREBRAL ISCHEMIA IN SAH

预测 SAH 迟发性脑缺血

• 批准号: 6139439
• 负责人: Mary E. Kerr
• 金额: $ 37.62万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-04-01 至 2002-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6139439
• 关键词: blood flow measurement; brain circulation; brain electrical activity; cerebral ischemia /hypoxia; cerebrovascular disorder diagnosis; clinical research; computed axial tomography; diagnosis design /evaluation; electroencephalography; human subject; neurophysiology; oximetry; patient monitoring device; subarachnoid hemorrhage; subarachnoid space

Subarachnoid hemorrhage (SAH) is a clinical emergency occurring to healthy individuals that involves a sudden rupture of a cerebral vessel and hemorrhage into the space between the brain arachnoidea. If the person survives the initial SAH injury, 50 to 60% will develop symptoms of impending delayed cerebral ischemia (DCI), 5-10 days following the initial injury. There is evidence suggesting that decreased cerebral oxygenation or brain activity from DCI may be detected by multimodal neurophysiologic (NP) monitoring, however, no systematic study has been undertaken to compare the sensitivity and specificity of NP monitoring against the traditional standard of care periodic clinical nursing neurologic assessment. The purpose of this study is to examine the efficacy of bedside multimodal NP monitoring compared to a routine neurologic examination in the detection of the clinical emergency, DCI, in patients with severe SAH. The specific aims of this project are to: 1) examine the detection of DCI after SAH using either multimodal NP monitoring (blood flow velocity, 2 indices of cerebral oxygenation and a single index of brain electrical activity) in combination with the clinical neurologic examination and 2) determine whether multimodal NP monitoring detects DCI earlier when compared to the current standard of care, the clinical neurologic examination. Using a within subject repeated measure design, data will be collected on blood flow velocity, two indices of cerebral oxygenation using near-infrared technology and electroencephalography bispectral index as well as the clinical neurologic examination from days 5 through 10 inclusive following a severe SAH in 80 patients at risk for DCI.. Global cerebral blood flow studies using 133 Xe at the bedside will be conducted daily to examine trends in flow; the presence of DCI will be verified by regional low flow as detected using xenon-enhanced computed tomography CBF . Sensitivity and specificity will be estimated and compared between the neurologic examination and the individual methods of NP monitoring A one way within subjected repeated measures analysis of variance will be used to compare the time of detection by types of monitoring in patients with verified DCI.

蛛网膜下腔出血（SAH）是发生的临床紧急事件 涉及大脑突然破裂的健康个体 血管和出血进入脑蛛网膜菌之间的空间。 如果该人在最初的SAH受伤中幸存下来，则会发展50％至60％ 即将延迟脑缺血（DCI）的症状，5-10天 最初受伤后。 有证据表明 DCI的脑充氧或大脑活性降低可能是 但是，通过多模式神经生理（NP）监测检测 已经进行了系统研究以比较敏感性和 NP监控对传统护理标准的特异性 定期临床护理神经系统评估。 这项研究的目的是检查床边的功效 与常规神经系统检查相比，多模式NP监测 在检测临床紧急情况下，DCI患者 严重的SAH。 该项目的具体目的是：1）检查 SAH后使用任一多模式NP监控检测DCI （血流速度，2个脑充氧的指标和一个单一的指标 脑电活动的指数）与临床结合 神经检查和2）确定多模式NP是否 与当前标准相比，监视较早检测到DCI 护理，临床神经检查。 使用内部主题 重复的措施设计，将收集有关血流的数据 速度，使用近红外的两个脑充氧的指标 技术和脑电图双光谱指数以及 第5至第10天的临床神经检查检查 在80名有DCI风险的患者中发生严重的SAH。全球 使用133 XE在床边使用的脑血流研究将是 每天进行检查流动趋势； DCI的存在将 通过使用氙气增强检测到的区域低流量验证 计算机断层扫描CBF。灵敏度和特异性将是 估计和比较神经系统检查和 NP监视的单个方法。 重复测量方差分析将用于比较 通过经过验证的患者进行监测的类型检测时间 DCI。