Диагностика и прогнозирование внутричерепной гипертензии по данным первичной компьютерной томографии у пострадавших с тяжелой черепно-мозговой травмой

 The objective was to compare the optic nerve sheath diameter measured by CT (ODSN-CT) with the level of compression of the mesencephalic  cisterns and the midline shift in the diagnosis and prediction of intracranial hypertension (ICH) during the first 3 days after brain injury. Materials and methods. We examined 90 patients with TBI, the average age was 34.2 ± 13 years, GCS < 9. All patients had invasive ICP monitoring.  At the time of implantation of the ICP sensor, intracranial hypertension (ICH) was in 11 (12%) patients; later, during the first 3 days, the development of ICH was in 58 (64%) patients. All patients underwent computed tomography of the head at the time of hospitalization: mesencephalic  cisternae was compressed in 57 (63%) and midline shift was observed in 34 (38%) patients, mean value of ONSD-CT was 7.26 ± 0.9 mm, maximum  value of ONSD-CT was 7.34 ± 0.9. We used correlation analysis, logistic regression and ROC-analysis.Results. The level of mesencephalic cisternae compression, mean and maximum value of ONSD-CT correlated with the ICP value measured at the  time of ICP sensor implantation and during the first 72 hours after brain injury (p < 0.05). Midline shift did not correlate with ICP value measured  at the time of sensor implantation and during the first 72 hours after brain injury (p > 0.05). In the diagnosis of ICP > 20 mm Hg at the time of  implantation of the sensor – the average ONSD-CT, AUC 0.902 ± 0.046 (0.812; 0.991), cut-off 7.8 mm with sensitivity and specificity of 82 and  80%, respectively. When predicting ICP > 20 mm Hg in the first 72 hours - the maximum ONSD-CT, AUC 0.815 ± 0.047 (0.724; 0.907), cut-off  7.1 mm with sensitivity and specificity of 85 and 66%, respectively.Conclusions. The ONSD-CT parameter is an independent diagnostic and prognostic criterion of ICH in the first 3 days in patients with severe  TBI. The mean ONSD-CT can be used to diagnose ICH along with such signs of ICP as level of mesencephalic cisterna compression and midline  shift and to make a decision on invasive ICP monitoring. The maximum value of ONSD-CT can be used to assess the probability of ICH in the  first three days after TBI Цель – сравнить диаметр зрительного нерва с оболочками по данным компьютерной томографии (ДЗНО-КТ) со степенью компрессии  мезенцефальных цистерн и смещением срединной линии при диагностике и прогнозировании внутричерепной гипертензии (ВЧГ) в первые  3 суток с момента травмы. Материалы и методы. Обследовали 90 пострадавших с ЧМТ, средний возраст 34,2 ± 13 лет, ШКГ менее 9 баллов. Всем проводили инвазивный мониторинг внутричерепного давления (ВЧД). На момент установки датчика ВЧД ВЧГ диагностирована у 11 (12%) пострадавших,  в дальнейшем течение первых 3 суток развитие ВЧГ регистрировали у 58 (64%) пострадавших. Всем пациентам выполняли КТ головы на  момент госпитализации. При КТ-исследовании компрессия мезенцефальных цистерн была у 57 (63%) и смешение срединной линии – у  34 (38%) пострадавших, среднее значение ДЗНО – 7,26 ± 0,9 мм, максимальное ДЗНО – 7,34 ± 0,9. Использовали корреляционный анализ,  логистическую регрессию и ROC-анализ. Результаты. Степень компрессии мезенцефальных цистерн, среднее и максимальное ДЗНО коррелировали со значением ВЧД, измеренном  на момент постановки датчика и за первые 72 часа мониторинга (p < 0,05). Смещение срединной линии не коррелировало со значением  ВЧД, измеренном на момент постановки датчика и за первые 72 часа мониторинга (p > 0,05). При диагностике ВЧД > 20 мм рт. ст. на момент имплантации датчика – среднее ДЗНО, AUC 0,902 ± 0,046 (0,812; 0,991), cut-off 7,8 мм с чувствительностью и специфичностью 82 и  80% соответственно. При прогнозировании ВЧД > 20 мм рт. ст. в первые 72 часа – максимальное ДЗНО, AUC 0,815 ± 0,047 (0,724; 0,907),  cut-off 7,1 мм с чувствительностью и специфичностью 85 и 66% соответственно. Выводы. Параметр ДЗНО-КТ является самостоятельным диагностическим и прогностическим критерием ВЧГ в первые 3 суток у пострадавших с тяжелой ЧМТ. Среднее значение ДЗНО-КТ можно использовать для диагностики ВЧГ наряду с такими признаками ВЧГ, как  степень компрессии мезенцефальных цистерн и смещение срединной линии, для принятия решения об инвазивном мониторинге ВЧД.  Максимальное значение ДЗНО-КТ можно использовать для оценки вероятности ВЧГ в первые 3 суток после ЧМ

COMPARISON OF THERAPIES BASED ON CARVEDILOL AND METOPROLOL IN HYPERTENSIVE PATIENTS WITH OVERWEIGHT OR OBESITY. THE FIRST RESULTS OF CAMELLIA TRIAL

Aim. To evaluate antihypertensive and metabolic effects of the therapy based on carvedilol (C) in comparison with metoprolol (M) in hypertensive patients with overweight or obesity.Material and methods. 320 patients were involved in multicenter, randomized open parallel study. One part of the patients received C 12,5 mg BID (Vedicardol, “Sintez”), another part – M 25 mg/day BID. Doubling dose of β-blockers (BB) and switching patients to combined therapy with AML 5-10 mg OD (Amlorus, “Sintez”) and hydrochlorothiazide (HCT) 12,5-25 mg OD was performed if necessary. The study duration was 24 weeks.Results. Significant reduction of systolic and diastolic blood pressure was revealed in both groups, there was no difference between groups (р=0,88 and p=0,61 respectively). Switching patients to combined therapy with AML and HCT was made more often in M group than in C group (p&gt;0,05). Prescription of BB resulted in significant reduction of the heart rate, there was no difference between groups (p=0,61). 96,2% patients of group C and 95,5% of group M reached target levels of BP. Significant reduction of glucose (p&lt;0,01) and uric acid levels were registered in group C as well as tendency to lowering of total cholesterol (TC) and low density lipoprotein cholesterol (LDLC) levels. 34 adverse effects were registered during observation period: 24 in group C and 10 in group M (p&gt;0.05), half of them were not related to BB taking.Conclusion: Controlled antihypertensive therapy, based on С and M, allows reaching target levels of BP in majority of patients with overweight or obesity. Switching to combined therapy was made more seldom in group of С than in M group. Both drugs demonstrated metabolic neutrality, however significant lowering of glucose and uric acid levels and tendency to lowering of TC an LDLC levels was observed only in group С.</p