PREDICTING DELAYED CEREBRAL ISCHEMIA IN SAH

蛛网膜下腔出血(SAH)是一种临床急症，发生于 健康的人，涉及大脑突然破裂 血管和出血进入脑蛛网膜之间的间隙。 如果患者在最初的SAH损伤中存活下来，将有50%到60%的人发生 即将出现的迟发性脑缺血(DCI)症状，5-10天 在最初的受伤之后。有证据表明 DCI引起的脑氧合或脑活动降低可能是 然而，通过多模式神经生理学(NP)监测发现，NO 已经进行了系统的研究，以比较敏感性和 NP监测相对于传统护理标准的特殊性 定期进行临床护理神经学评估。 这项研究的目的是检查床边的疗效。 多模式NP监测与常规神经学检查的比较 在临床紧急情况的检测中，DCI患者 严重的SAH。这个项目的具体目的是：1)检查 任一种多模式NP监测SAH后DCI的检测 (血流速度，两个脑氧合指数和一个单一的 脑电活动指数)结合临床 神经学检查和2)确定多模式NP 与当前标准相比，监控可以更早地检测到DCI 对护理，临床神经学检查。在主语中使用 重复测量设计，将收集有关血流的数据 近红外脑氧合的两个指标--速度 技术和脑电双谱指数以及 第5天至第10天(含)的临床神经检查 在80名有DCI风险的患者发生严重SAH后。全球 在床边使用133 Xe进行脑血流研究将是 每天进行，以检查流动趋势；DCI的存在将 用氙气增强技术检测到的区域低流量进行验证 计算机断层扫描脑血流量。敏感度和特异度 评估和比较神经学检查和 NP监测的个人方法受试者内的一种方法 将使用重复测量的方差分析来比较 经核实的患者按监测类型进行检测的时间 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.