The incidence of dysautonomia and its relationship with autonomic arousal following traumatic brain injury
The incidence of dysautonomia and its relationship with autonomic arousal following traumatic brain injury
复制标题
DOI：
10.1080/02699050701687375
复制
发表时间：
2007-10-01
期刊：
影响因子：
1.9
通讯作者：
Nayyar, Vineet
中科院分区：
文献类型：
--
作者：
Baguley, Ian J.;Slewa-Younan, Shameran;Nayyar, Vineet
主要目标：确定重症监护病房 (ICU) 中创伤性脑损伤 (TBI) 后自主神经觉醒与自主神经功能障碍的发生率，并根据损伤严重程度和结果变量前瞻性评估这些组。研究设计：对一家大型创伤医院连续 2 年入住 ICU 的前瞻性观察组比较（队列）研究。主要结局和结果：113 名受试者中的 89 名符合纳入和排除标准，79 名受试者获得同意（61 名男性，18 名女性：潜在受试者的 89%）。在受伤后的前 7 天内，样本中几乎普遍存在自主神经参数升高（92%），主要是高血压和心动过速。 79 名受试者中有 19 名 (24%) 在第 7 天出现自主神经兴奋（即心率、呼吸频率、血压和体温升高）。根据之前公布的标准，79 名受试者中有 6 名 (8%) 在受伤后第 14 天被诊断出自主神经功能异常。与非觉醒受试者相比，自主觉醒受试者的损伤明显更严重，结果更差，估计成本更高。此外，自主神经唤醒组内的自主神经功能障碍受试者的预后明显较差，并且（排除早期死亡）住院时间更长，估计费用更高。结论：入住 ICU 期间自主神经功能障碍的发生率为 8%，与之前的研究基本一致。虽然第 7 天的自主神经唤醒表明损伤程度更大，但自主神经功能障碍的诊断提供了额外的预后信息。针对这种情况进行协调的多中心研究似乎是合适的。
Primary objective: To determine the incidence of autonomic arousal vs. Dysautonomia following traumatic brain injury ( TBI) in an Intensive Care Unit ( ICU) setting and to prospectively evaluate these groups against injury severity and outcome variables. Research design: Prospective observational group comparison (cohort) study of consecutive ICU admissions to a major trauma hospital over a 2-year period. Main outcomes and results: Eighty-nine of 113 subjects met inclusion and exclusion criteria, with consent gained for 79 subjects ( 61 male, 18 female: 89% of potential subjects). During the first 7 days post-injury, elevated autonomic parameters were almost universal in the sample ( 92%), predominantly hypertension and tachycardia. Nineteen of 79 subjects ( 24%) were autonomically aroused on day 7 ( that is, had elevated heart rate, respiratory rate, blood pressure and temperature). Dysautonomia was diagnosed on day 14 post-injury in six of 79 subjects ( 8%) using previously published criteria. Autonomically aroused subjects had significantly more severe injuries, poorer outcomes and greater estimated costs than non-aroused subjects. Furthermore, Dysautonomic subjects within the autonomically aroused group had significantly worse outcome and, excluding early deaths, a greater period of hospitalization and higher estimated costs. Conclusions: The 8% incidence of Dysautonomia during ICU admission was in broad agreement with previous research. While day 7 autonomic arousal indicated a greater degree of injury, the diagnosis of Dysautonomia provided additional prognostic information. A coordinated multi-centre research effort into this condition appears appropriate.