Novi trendovi u neuromonitoringu bolesnika sa aneurizmalnom subarahnoidnom hemoragijom

Neurointensive care of patients with subarachnoid haemorrhage is based on the theory that clinical outcome is the consequence of the primary haemorrhage and a number of secondary insults in the acute post haemorrhage period. Several neuromonitoring techniques have been introduced or accomplished into clinical practice in the last decade with the purpose of monitoring different but related aspects of brain physiology, such as cerebral blood flow (CBF), pressure within the cranial cavity, metabolism, and oxygenation. The aim of these techniques is to obtain information that can improve knowledge on brain pathophysiology, and especially to detect secondary insults which may cause permanent neurological damage if undetected and untreated in 'real time', at the time when they can still be managed. These techniques include intracranial pressure (ICP) measurements, jugular venous oxygen saturation, near-infrared spectroscopy, brain tissue monitoring, and transcranial Doppler. The available devices are limited because they measure a part of complex process indirectly. Expense, technical difficulties, invasiveness, limited spatial or temporal resolution and the lack of sensitivity add to the limitation of any individual monitor. These problems have been partially addressed by the combination of several monitors known as multimodality monitoring. In this review, we describe the most common neuromonitoring methods in patients with subarachnoidal hemorrhage that can assess nervous system function, cerebral haemodynamics and cerebral oxygenation.Neurointenzivna nega bolesnika sa subarahnoidnom hemoragijom bazira se na shvatanju da klinički oporavak zavisi od primarne hemoragije i brojnih sekundarnih oštećenja u akutnom post hemoragijskom periodu. Nekoliko novih tehnika neuromonitoringa počelo se primenjivati, ili je usavršeno u kliničkoj praksi, u poslednjoj dekadi sa namerom praćenja različitih ali povezanih aspekata moždane fiziologije, kao što su cerebralni krvni protok, pritisak unutar kranijuma, cerebralni metabolizam i cerebralna oksigenacija. Cilj ovih tehnika je da se poboljšaju znanja iz moždane patofiziologije, i posebno da se otkriju sekundarni poremećaji koji mogu da dovedu do trajnih neuroloških oštećenja ako se na vreme ne otkriju i ne tretiraju. Ove tehnike obuhvataju kontinuirano merenje intrakranijalnog pritiska, monitoring jugularne venske oksimetrije, near-infrared spectroscopiju, monitoring cerebralnog tkiva i transkranijalni Doppler. Raspoložive metode su limitirane jer mere indirektno samo deo kompleksnih cerebralnih funkcija. Skupoća merenja, tehnička složenost, invazivnost, limitiranost prostorom i vremenom primene, mala osetljivost predstavljaju limitirajuće faktore svake pojedinačne metode. Ovi problemi se mogu delimično rešiti kombinacijom nekoliko metoda merenja, što je poznato kao multimodalitetni monitoring. U ovom radu razmatraju se najčešće primenjene metode monitoringa za procenu funkcije nervnog sistema, cerebralne hemodinamike i cerebralne oksigenacije

Razlika u vrednostima gasnih analiza arterija i unutrašnje jugularne vene kod bolesnika sa infarktom mozga

Introduction. Cerebral infarction is more and more frequently present by massive participation and high percentage of mortality even in young population. It is notified as very hard, vitally endangered disease. Objective. To prove whether there is a difference in the gas analyses of the arterial and cerebral venous blood between the patients with the cerebral infarction of the left and right hemisphere and why it is significant for the treatment of those patients. Material and methods. Sixty-five (65) patients of both sexes who were diagnosed by CT as: cerebral infarction, cerebral multiinfarctions and cerebral haemorrhagic infarctions were investigated. Under the same conditions their radial artery and left and right internal jugular vein were tapped - on the fourth, eighth and tenth day of their disease. Gas analysis, calculation of oxygen content and statistical comparison of testing results were performed from the samples of arterial and venous blood. Results. By continuous monitoring of gas analysis parameters of arterial and cerebral venous blood from internal jugular vein, we can follow up the phases of disease, the velocity of changes of gas analysis parameters and adequacy of brain circulation and to correct therapy adequately for the purpose of preventing basic disease complications and to estimate the results of treatment. Conclusion. There is a significant difference between the results of gas analysis of arteries and the internal jugular vein, in patients with infarctions of the left and right hemisphere of the brain.Uvod. Infarkti mozga su sve češće zastupljeni i kod mlađe populacije. Praćeni su visokim procentom mortaliteta. Zato ih svrstavamo u teška, vitalno ugrožavajuća oboljenja. Cilj rada. Dokazati da li postoji terapijski značajna razlika u gasnim analizama arterijske i venske krvi (unutrašnje jugularne vene), kod infarkta leve i desne hemisfere mozga. Metod rada. Ispitivano je 65 bolesnika, oba pola, koji su imali dijagnozu verifikovanu kompjuterizovanom tomografijom (CT): infarkt, multiinfarkti i hemoragijski infarkti mozga. Pod jednakim uslovima punktirane su im: arteria radialis, leva i desna unutrašnja jugularna vena - četvrtog, osmog i desetog dana bolesti. Iz uzoraka arterijske i venske krvi rađene su gasne analize i izračunavan sadržaj kiseonika. Rezultati su međusobno upoređivani i obrađivani odgovarajućim statističkim metodama. Rezultati. Kontinuiranim praćenjem parametara gasnih analiza arterijske i venske krvi (unutrašnje jugularne vene) uočene su različite faze bolesti, brzina promene parametara gasnih analiza, stepen adekvatnosti moždane cirkulacije - to sve pomaže u korigovanju terapije, prevenciji komplikacija osnovne bolesti i procenjivanju ishoda lečenja. Zaključak. U gasnim analizama arterija i unutrašnje jugularne vene kod bolesnika sa infarktom leve i desne hemisfere mozga postoji značajna razlika