ABSTRACT
Objective: To find out the relationship between the use of different dosages of mannitol and the changes of cerebral blood flow in patients with stroke at the peak of edema formation. Methods: Twenty-eight patients with hemispheric stroke were treated with 20% mannitol solution for reduction of increased intracranial pressure, at the dosages of 125 ml or 250 ml. Transcranial Doppler was used to monitor the blood flow of the bilateral middle cerebral arteries before and after the treatment. The monitoring parameters included peak systolic velocity (Vs), end diastolic velocity (Vd), mean velocity (Vm), and pulsatility index (PI), and percentage rate (PR) of change in each parameter. At the same time, the blood pressure of brachial artery was monitored. Results: Vs, Vd, and Vm on the affected and unaffected sides were improved significantly in patients using 125 ml mannitol. The PI on the affected sides decreased markedly (P = 0.002, P = 0.028) from 45 min to 60 min; the PI on the unaffected sides did not decrease significantly (P > 0.05); there were no significant differences in the PR of Vs, Vd, Vm and PI on both sides (P > 0.05). Vs, Vd, and Vm on the affected and unaffected sides were improved fluctuatly in patients using 250 ml mannitol. The PI on the affected sides did not decrease markedly (P > 0.05 ); the PI on the unaffected sides decreased significantly (P = 0.005) 60 min after mannitol infusion; the PR of PI at 60 min had significant difference between two sides (P = 0.006). The peaks of the velocity of blood flow increasing and PI decreasing on the affected sides occured later than that on the unaffected sides in patients both using 125 ml and 250 ml mannitol. Conclusion: The improvement of cerebral hemodynamics on the affected sides is more significant than that on the unaffected sides with 125 ml mannitol, and the improvement of cerebral hemodynamics on the unaffected sides is more significant than that on the affected sides with 250 ml mannitol.
ABSTRACT
<p><b>BACKGROUND</b>Coma after cardiopulmonary resuscitation (CPR) is commonly seen in daily clinical practice. How to objectively evaluate brain function after CPR is essential to the following treatment. Coma patients after CPR had been studied prospectively at the Neuro-Intensive Care Unit of Xuanwu Hospital since 2002. In this study, we focused on the topic of how to evaluate the severity of coma after CPR.</p><p><b>METHODS</b>From April 2002 to November 2004, patients in coma 24 hours after CPR were monitored, the evaluation methods included Glasgow coma score (GCS), brain stem reflection, and spinal reflection. Laboratory evaluation included electroencephalography (EEG), brainstem auditory evoked potential (BAEP), short latency somatosensory evoked potential (SLSEP), and transcranial Doppler (TCD).</p><p><b>RESULTS</b>Twenty-four of 35 patients (68.57%) were in deep coma. The GCS was 3 except for 2 patients; EEG was evaluated not less than grade IV except for 4 patients, BAEP was evaluated as grade III except for 3 patients, and SLSEP was evaluated as grade III except for 1 patient. Twenty-four patients died within 1 month and 11 of them (45.83%) were determined as brain death. Glasgow outcome score (GOS) was evaluated as grade I. Eleven of the 35 patients survived and their consciousness changed from deep coma to coma vigil. EEG was evaluated as gradeIin 5 patients, BAEP and SLSEP were evaluated as grade I in 3 patients, and GOS was all evaluated as grade II among the 11 patients. Two patients (18.18%) regained consciousness in 35 and 90 days after cardiopulmonary resuscitation and GOS was evaluated as grade IV and III, respectively.</p><p><b>CONCLUSION</b>Combined or continuous evaluation of clinical examinations and laboratory tests can accurately and objectively determine brain function after CPR.</p>