ABSTRACT
Objective:To explore the mechanism,clinical features,and prognosis of trigemino-cardiac reflex (TCR) during skull base operations.Methods:A retrospective analysis was performed on 291 patients with skull base disease from Jan.2009 to Oct.2015 in Peking University First Hospital.By reviewing the patients' operative data and anaesthetic electrical record,and we picked out all the patients who suffered from TCR during the operation and analyzed their surgical procedures,clinical features,influence factors,and prognosis.TCR was defined as a drop in mean arterial blood pressure (MABP) and the heart rate (HR) of more than 20％ to the baseline values before the stimulus and coinciding with the manipulation of the trigeminal nerve.Results:In all the 291 patients receiving skull base surgery,9 patients suffering TCR for 19 times during the operation were found.These 9 cases included three acoustice schwannomas,one trigeminal schwannoma,one petroclival meningioma,one epidermoid cyst in cerebellopontine angle,one cavernous sinus cavernous hemangioma,one pituitary adenoma,and one trigeminal neuralgia.The trigger of TCR was related to manipulation,retraction,and stimulation of the trunk or branches of trigeminal nerve.The baseline heart rate was 62-119/min [mean (79.4 ± 14.6) /min] and dropped about 29.0％-66.4％ (mean 44.3％) to 22-60/min [mean (44.2 ±9.6) /min] after TCR.The baseline mean arterial blood pressure was 75-103 mmHg [mean (87.5 ±7.8) mmHg] and dropped about 23.4％-47.2％ (mean 37.3 ％) to 45-67 mmHg [mean (54.9 ± 6.3) mmHg] after TCR.During the 19 times of TCR,heart rate and blood pressure could return to baseline in a short time while stopping manipulation (8 times),using atropine (8 times,dose 0.5-1.0 mg,mean 0.69 mg),using ephedrine hydrochloride (one time,15 mg),using epinephrine (one time,1 mg),and using dopamine (one time,2 mg).TCR also could be triggered again by a second stimulation.There was no relative cardiologic complication or neurological deficit in the postoperative 24 hours.Conclusion:TCR is a short neural reflex with a drop in blood pressure and heart rate coinciding with the manipulation of the trigeminal nerve in skull base surgery.Correct recognition,intensive observation,and essential management of TCR will lead to a good prognosis.
ABSTRACT
[Summary] Traumatic brain injury ( TBI ) constitutes a major health and socioeconomic problem throughout the world . Increasing traffic accidents and aging of population promote the incidence of TBI .In patients with severe TBI mortality and disability rates are higher .And survivors may suffer physical activity , cognitive and psychological problems due to trauma , leading to shortened life span and higher risk of death than general population .They are also facing with long-term care and rehabilitation .This article reviewed the status and limitations on treatment of severe traumatic brain injury and its clinical significance .
ABSTRACT
Objective To investigate the correlation between plasma NT-proBNP and the severity of coronary artery disease. Methods One hundred and eighty five subjects were divided into three groups:83 patients in acute coronary syndromes group, 62 patients in stable angina pectoris group and 40 healthy subjects in normal group. The plasma NT-proBNP concentrations were measured by enzyme-linked immunosorbent assay (ELISA) . The plasma NT-proBNP levels of acute coronary syndrome patients and stable angina patients were analyzed. Furthermore, the coronary syndrome patients were divided into three groups according to the result of angiography:single vessel group, dual-vessel group and multiple-vessel group. The relationship of plasma NT-proBNP levels with the severity of coronary artery disease was analyzed. Results (1) In the group of acute coronary syndromes, the plasma NT-proBNP concentrations were obviously higher than the stable angina pectoris group and normal group (P<0.01) . (2) In the groups of coronary heart disease, the plasma NT-proBNP concentrations of the multiple-vesel group were obviously higher than the single vessel group and the dual-vessel group (P<0.01) . The plasma NT-proBNP concentrations of dual-vessel group were obviously higher than the single vessel group (P<0.01) . (3) The plasma NT-proBNP levels and the severity of coronary lesions were positively correlated (rs=-0.796, P<0.01) . Conclusion The plasma NT-proBNP levels is closely related to the severity of coronary artery disease.