Clinical Study Of Multimodal Monitoring For Evaluation Of Condition And Prognosis Of Patients With Moderate And Severe Craniocerebral Injury

Objective: In this study,the changes of ICP,brain temperature,biomarkers in serum and cerebrospinal fluid and EEG in patients with moderate and severe TBI after injury were dynamically monitored,and the clinical significance of MMM on the condition and prognosis of TBI patients was discussed from ICP,brain metabolism and brain function.Materials and Methods: 28 patients with moderate TBI and 28 patients with severe TBI from March 2020 to August 2021 in the Second Neurosurgery Department of the Second Affiliated Hospital of Lanzhou University were collected for a self-controlled experiment.According to Glasgow Coma Scale（GCS）,the GCS scores of patients in moderate and severe groups were 9 ～ 12 and 3 ～ 8,respectively.The GCS of all hospitalized patients was assessed.ICP and brain temperature were dynamically monitored for 7 days,recorded once every hour.At the same time,on the1 st,3rd and 7th day,the blood and cerebrospinal fluid of the patients were sampled to measure the myelin basic protein（MBP）,microtubule-associated protein tau（Tau protein）and blood-brain barrier（BBB）index（CSF albumin/serum albumin）.EEG for all patients was collected within 24 hours after admission for 8 hours.Four quantitative electroencephalogram（QEEG）indexes of TBI patients in moderate and severe groups were analyzed and compared,containing relative α power（RAP）,relative δ power（RDP）,the ratio of δ and α power（DAR）,the ratio of（δ+θ）and（α+β）power（DTABR）.Six months after injury,according to the basic information in patients’ electronic medical records,patients or their families were followed up by telephone,and then patients were divided into unfavorable prognosis group and favorable prognosis group by Glasgow Outcome Scale（GOS）.All the data collected in the experiment were processed by SPSS22.0 statistical software.Results:（1）ICP,serum and cerebrospinal fluid biomarker concentrations,RDP,DAR and DTABR in severe TBI patients were higher than those in moderate TBI patients during the monitoring period,while brain temperature and RAP were lower than those in moderate TBI patients;（2）ICP,serum and cerebrospinal fluid biomarker concentrations,RDP,DAR and DTABR of TBI patients with poor prognosis are higher than those of TBI patients with good prognosis,while brain temperature and RAP are lower than those of TBI patients with good prognosis.（3）The concentrations of MBP and Tau protein in cerebrospinal fluid in moderate and severe groups were significantly higher than those in serum.（4）There was a positive correlation between MBP concentration in serum and MBP concentration in cerebrospinal fluid（r=0.8124）,and there was a positive correlation between Tau protein concentration in serum and Tau protein concentration in cerebrospinal fluid（r=0.9235）.（5）ICP,serum and cerebrospinal fluid biomarker concentrations,RDP,DAR and DTABR are negatively correlated with GOS,while brain temperature and RAP are positively correlated with GOS.Conclusions: The pathophysiology of patients with moderate and severe TBI are a complicated process.MMM can evaluate and monitor patients from various angles,including ICP,cerebral blood flow,cerebral metabolism and brain function,to guide clinical treatment.The more serious the disease,the higher ICP,serum and cerebrospinal fluid biomarker concentration,RDP,DAR and DTABR,the lower RAP and brain temperature,and the worse the clinical prognosis.Therefore,dynamic monitoring of ICP,brain temperature,concentration of biomarkers in cerebrospinal fluid and serum and EEG changes can assist diagnose and treat the TBI patients and evaluate the prognosis.