PREDICTING DELAYED CEREBRAL ISCHEMIA IN SAH

蛛网膜下腔出血（SAH）是一种临床急症， 健康的人，涉及大脑的突然破裂， 血管和出血进入大脑蛛网膜之间的空间。 如果患者在最初的蛛网膜下腔出血损伤后存活， 即将发生的迟发性脑缺血（DCI）症状，5-10天 在最初的伤害之后。 有证据表明 DCI导致的脑氧合减少或脑活动可能 通过多模式神经生理学（NP）监测检测到，然而，没有 进行了系统的研究，比较敏感性， NP监测相对于传统护理标准的特异性 定期临床护理神经功能评估。 本研究的目的是检查床边 与常规神经系统检查相比，多模式NP监测 在检测临床紧急情况，DCI，在患者 严重SAH。 该项目的具体目标是：1）审查 使用多模式NP监测检测SAH后的DCI （血流速度，2个脑氧合指数和一个单一的 脑电活动指数）结合临床 神经系统检查和2）确定是否多模态NP 与当前标准相比，监控更早地检测到DCI 护理，临床神经系统检查。 使用内部主题 重复测量设计，将收集血流数据 速度，使用近红外的脑氧合的两个指标 技术和脑电图双频指数以及 第5天至第10天（含）的临床神经系统检查 在80例有DCI风险的患者中发生重度SAH后。全球 在床旁使用133 μ M进行脑血流研究， 每天进行，以检查流量趋势; DCI的存在将 通过使用氙增强探测器探测到的区域低流量进行验证 计算机断层扫描CBF。灵敏度和特异性将是 估计并比较神经系统检查和 NP监测的个别方法 重复测量方差分析将用于比较 按监测类型分列的经验证的 总督察

Subarachnoid hemorrhage (SAH) is a clinical emergency occurring to healthy individuals that involves a sudden rupture of a cerebral vessel and hemorrhage into the space between the brain arachnoidea. If the person survives the initial SAH injury, 50 to 60% will develop symptoms of impending delayed cerebral ischemia (DCI), 5-10 days following the initial injury. There is evidence suggesting that decreased cerebral oxygenation or brain activity from DCI may be detected by multimodal neurophysiologic (NP) monitoring, however, no systematic study has been undertaken to compare the sensitivity and specificity of NP monitoring against the traditional standard of care periodic clinical nursing neurologic assessment. The purpose of this study is to examine the efficacy of bedside multimodal NP monitoring compared to a routine neurologic examination in the detection of the clinical emergency, DCI, in patients with severe SAH. The specific aims of this project are to: 1) examine the detection of DCI after SAH using either multimodal NP monitoring (blood flow velocity, 2 indices of cerebral oxygenation and a single index of brain electrical activity) in combination with the clinical neurologic examination and 2) determine whether multimodal NP monitoring detects DCI earlier when compared to the current standard of care, the clinical neurologic examination. Using a within subject repeated measure design, data will be collected on blood flow velocity, two indices of cerebral oxygenation using near-infrared technology and electroencephalography bispectral index as well as the clinical neurologic examination from days 5 through 10 inclusive following a severe SAH in 80 patients at risk for DCI.. Global cerebral blood flow studies using 133 Xe at the bedside will be conducted daily to examine trends in flow; the presence of DCI will be verified by regional low flow as detected using xenon-enhanced computed tomography CBF . Sensitivity and specificity will be estimated and compared between the neurologic examination and the individual methods of NP monitoring A one way within subjected repeated measures analysis of variance will be used to compare the time of detection by types of monitoring in patients with verified DCI.