Accuracy of ultrasound-measured pulsatility index of central retinal artery in diagnosing low cerebral perfusion pressure in patients with traumatic brain injury / 中华麻醉学杂志

Objective:To evaluate the accuracy of ultrasound-measured pulsatility index (PI) of central retinal arteries in diagnosing low cerebral perfusion pressure (CPP) in the patients with traumatic brain injury.Methods:Fifty-five patients who were admitted to the surgical intensive care unit due to traumatic brain injury with continuous intracranial pressure monitoring were selected.At 72 h after surgery, continuous incracranial pressure and mean arterial pressure were recorded, and peak systolic velocity and end diastolic velocity of central retinal arteries were measured by ultrasound.The invasive CPP and PI were calculated.The correlation between PI and CPP was analyzed.The accuracy of central retinal pulse index in diagnosing low CPP was evaluated by the receiver operating characteristic curve.Results:PI was negatively correlated with CPP ( r=-0.655, P<0.01). The area under the receiver operating characteristic curve of PI in diagnosing low CPP was 0.863 (95% confidence interval 0.761-0.965), and the threshold value was 0.97, sensitivity 92.3%, and specificity 66.7%. Conclusion:Ultrasound-measured PI is more accurate in diagnosing low CPP in the patients with traumatic brain injury.

Accuracy of ultrasound-determined end-diastolic velocity of central retinal artery in diagnosing postoperative low cerebral perfusion pressure in patients with craniocerebral trauma / 中华麻醉学杂志

Objective@#To evaluate the accuracy of ultrasound-determined end-diastolic velocity (EDV) of central retinal artery (CRA) in diagnosing postoperative low cerebral perfusion pressure (CPP) in the patients with craniocerebral trauma.@*Methods@#Forty-nine patients of both sexes with brain injury, aged 18-64 yr, with body mass index of 18.5-23.9 kg/m2, were enrolled.The peak systolic velocity and EDV of CRA were determined using ultrasound at 1 day after operation.Mean arterial pressure and intracranial pressure were recorded, and CPP was calculated (CPP=mean arterial pressure-intracranial pressure).@*Results@#EDV was positively correlated with CPP (r=0.746, P<0.01), and peak systolic velocity was not correlated with CPP (P>0.05). The area under the receiver operating characteristic curve for EDV in diagnosing low CPP was 0.938 (95% confidence interval 0.871-1.000), and the critical value was 3.205 (sensitivity 94.4%, specificity 76.9%).@*Conclusion@#Ultrasound-determined EDV of central retinal artery can accurately diagnose postoperative low CPP in the patients with craniocerebral trauma.

Accuracy of ultrasound-determined end-diastolic velocity of central retinal artery in diagnosing postoperative low cerebral perfusion pressure in patients with craniocerebral trauma / 中华麻醉学杂志

Objective To evaluate the accuracy of ultrasound-determined end-diastolic velocity (EDV) of central retinal artery (CRA) in diagnosing postoperative low cerebral perfusion pressure (CPP)in the patients with craniocerebral trauma.Methods Forty-nine patients of both sexes with brain injury,aged 18-64 yr,with body mass index of 18.5-23.9 kg/m2,were enrolled.The peak systolic velocity and EDV of CRA were determined using ultrasound at 1 day after operation.Mean arterial pressure and intracranial pressure were recorded,and CPP was calculated (CPP =mean arterial pressure-intracranial pressure).Results EDV was positively correlated with CPP (r =0.746,P＜0.01),and peak systolic velocity was not correlated with CPP (P＞0.05).The area under the receiver operating characteristic curve for EDV in diagnosing low CPP was 0.938 (95％ confidence interval 0.871-1.000),and the critical value was 3.205 (sensitivity 94.4％,specificity 76.9％).Conclusion Ultrasound-determined EDV of central retinal artery can accurately diagnose postoperative low CPP in the patients with craniocerebral trauma.

Recanalization of occlusive extracranial internal carotid artery dissection through medication of anticoagulant and antiplatelet agents:report of two cases with literature review / 介入放射学杂志

Objective To determine the effectiveness and safety of antiplatelet and anticoagulant agents in the treatment of extracranial internal carotid artery dissection (eICAD). Methods Antiplatelet and anticoagulant agents were adopted to treat two cases of eICAD in our hospital. The clinical data were retrospectively analyzed and the medical literatures concerning eICAD, which were obtained from Pubmed database, were reviewed. Results Most researches advocated the empirical use of antiplatelet and anticoagulant agents in eICAD. About 30% of occluded eICAD could be reopened in 8 days and about 60% - 80% in 3 months after the onset of the disease. During the period of treatment, the rate of ischemic stroke recurrence, disability or death was 8.3%-14.3% in anticoagulant group, while it was 7% - 23.7% in antiplatelet group. Conclusion Antiplatelet agents can be used in patients with eICAD who are contraindicated to anticoagulants. Anticoagulants should be used as early as possible in patients who are not contraindicated to anticoagulants.