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Objective:To explore the significance of multimodal monitoring in the monitoring and treatment of neurocritical care patients.Methods:104 neurocritical care patients admitted to the department of Critical Care Medicine of Fujian Provincial Hospital from March 2019 to January 2020 were enrolled. Patients were randomly assigned into two groups, with 52 in each group. In the routine monitoring treatment group, heart rate, blood pressure, respiratory rate and the changes in consciousness and pupils were monitored after operation. The patients were treated with routine medicine to reduce intracranial pressure (ICP), maintain proper cerebral perfusion pressure (CPP), balance fluid intake and output, and maintain the airway clear. Patients in the multimodal monitoring treatment group were treated with invasive ICP monitoring, ultrasound to assess brain structure, ultrasound to measure optic nerve sheath diameter (ONSD), transcranial color doppler (TCCD), internal jugular venous blood oxygen saturation monitoring, near-infrared spectroscopy (NIRS), non-invasive cerebral blood oxygen saturation monitoring and quantitative electroencephalogram monitoring. According to the monitoring results, the patients were given targeted treatment with the goal of controlling ICP and improving brain metabolism. The length of intensive care unit (ICU) stay, the incidences of neurological complications (secondary cerebral infarction, cerebral hemorrhage, high intracranial pressure, etc.), and the incidences of poor prognosis [6 months after the onset of Glasgow outcome score (GOS) 1 to 3] were compared between the two groups. Spearman rank correlation analysis of the correlation between invasive ICP and the ICP value which was calculated by TCCD. The receiver operating characteristic (ROC) curve of invasive ICP and pulsatility index of middle cerebral artery (PI MCA) were used to predict poor prognosis. Results:The length of ICU stay in the multimodal monitoring treatment group was significantly shorter than that of the routine monitoring treatment group (days: 6.27±3.81 vs. 9.61±5.09, P < 0.01), and the incidence of neurological complications was significantly lower than that in the routine monitoring treatment group (9.62% vs. 25.00%, P < 0.05). In the multimodal monitoring treatment group, 37 cases had a good prognosis and 15 cases had a poor prognosis, while the routine monitoring treatment group had a good prognosis in 27 cases and a poor prognosis in 25 cases. The incidence of poor prognosis in the multimodal monitoring treatment group was lower than that of the routine monitoring treatment group (28.85% vs. 48.08%, P < 0.05). In the multimodal monitoring treatment group, the invasive ICP and PI MCA of patients with good prognosis were significantly lower than those of patients with poor prognosis [invasive ICP (mmHg, 1 mmHg = 0.133 kPa): 16 (12, 17) vs. 22 (20, 24), PI MCA: 0.90±0.33 vs. 1.39±0.58, both P < 0.01]. There was no significant difference in resistance index of the middle cerebral artery (RI MCA) between the good prognosis group and the poor prognosis group (0.63±0.12 vs. 0.66±0.15, P > 0.05). There was a positive correlation between the invasive ICP and the ICP value which was calculated by TCCD ( r = 0.767, P < 0.001). ROC curve analysis showed that the area under ROC curve (AUC) of invasive ICP for poor prognosis prediction was 0.906, the best cut-off value was ≥ 18 mmHg, the sensitivity was 86.49%, and the specificity was 86.67%. The AUC of PI MCA for poor prognosis prediction was 0.759, the best cut-off value was ≥ 1.12, the sensitivity was 81.08%, and the specificity was 60.00%. The AUC of invasive ICP was greater than PI MCA ( Z = 2.279, P = 0.023). Conclusion:Comprehensive analysis of multimodal monitoring indicators for neurocritical care patients to guide clinical treatment can reduce the length of hospital stay, and reduce the risk of neurosurgery complications and disability; invasive ICP can predict poor prognosis of neurocritical care patients.
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Objective To investigate the methods of diagnosis and treatment of pediatric and hebetic adrenocorticotropic hormone ( ACTH) secreting pituitary microadenoma. Methods The data of 10 patients with ACTH secreting pituitary microadenoma were retrospectively analysed. ACTH secreting pituitary microadenoma was diagnosed by clinical manifestations, biochemical and imaging findings, and 5 patients underwent bilateral inferior petrosal sinus sampling ( BIPSS). Transsphenoidal surgery was performed on all the patients under microscope, and the tumor specimens were detected by immunohistochemistry. Results Immunohistochemical examination revealed that ACTH was positive in 8 cases and negative in 2 cases. Patients were followed up for 12 to 63 months, 7 cases (70%) were cured, one (10%) achieved remission, and the other two (20%) experienced recurrence. Conclusion BIPSS is helpful in the diagnosis and localization of pediatric and hebetic ACTH pituitary microadenoma, and transsphenoidal surgery is the optimal choice of treatment.
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Objective: To investigate the relationship between C-reactive protein(CRP)and its-717MG polymorphismin atrial fibrillation(AD of the population of the city of Nantong.Methods:The relationships between AF and AF risk factors were analyzed by comparing genders,ages and body nlagS index(BWI)in 92 AF patients and 60 non-AF control subjects.The serum CRP levels were detected by immunoturbidimetry in of the two groups.The CRP-717MG polymorphism wa8 detected by polymerage chain reaction-restriction fragment-length polymorphism in patients and control subjects.Results:The sel3utm CRP level wag positively correlated with the left atrium internal diameter(LAD)in AF patient group(r=0.58,P＜0.01).The level of CRP Wag significantly higher in AF patient group compared with that of control group(P＜0.01).The serum CRP level Wag higher in patients with non-paroxysmal atrial fibrillation than that of patients with paroxysmal atrial fibrillation(P＜0.05).There Wag no significant difference in the frequency of CRP genotype between AF and control groups(P＞0.05).But the alleles frequency of the G Wag lower in AF group than that of control group(P＜0.05).Conclusion:The semm CRP level is associated with AF and its subgroups.The serum CRP level is positively correlated with LAD.The results suggest that the inflammation influences the AF though atrium reconstruction.The relationship between CRP-7 17A/G and AF stir needs further large-scale perspective studies.
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Objective To study the influence of PYLL on life span of residents. Methods The reduce of potential life span in Kunshan residents from 1982～1999 was analysed between the male and female. Results The life span reduced significantly in injury, poisoning and c ancer, which accounted for over 56% of total causes o f death in PYLL, especially, over 60 % in male. PYLL rate in male was higher than that in female. PYLL rate in male a nd female (except brain blood vessel disease) from 1991～1999 was lower than tha t from 1982～1990. It was consistent with increasing of old age population pr oport ion and prolonging of expected life span in Kunshan residents year by year. Conclusions The reasons that causes to death of residents were injury a nd poisoning and cancer.