Decompressive Craniectomy Improves QTc Interval in Traumatic Brain Injury Patients

被引:2
作者
Dabrowski, Wojciech [1 ]
Siwicka-Gieroba, Dorota [1 ]
Robba, Chiara [2 ]
Badenes, Rafael [3 ]
Kotfis, Katarzyna [4 ]
Schlegel, Todd T. [5 ,6 ]
Jaroszynski, Andrzej [7 ]
机构
[1] Med Univ Lublin, Dept Anaesthesiol & Intens Care, PL-20954 Lublin, Poland
[2] Policlin San Martino, Dept Anaesthesia & Intens Care, I-1100 Genoa, Italy
[3] Univ Valencia, Hosp Clin Univ Valencia, Dept Anaesthesiol & Intens Care, Valencia 46010, Spain
[4] Pomeranian Med Univ, Dept Anaesthesiol Intens Therapy & Acute Intoxica, PL-70111 Szczecin, Poland
[5] Karolinska Inst, Dept Mol Med & Surg, SE-17176 Stockholm, Sweden
[6] Nicollier Schlegel SARL, CH-1270 Trelex, Switzerland
[7] Jan Kochanowski Univ Kielce, Coll Med, Dept Nephrol, PL-25736 Kielce, Poland
关键词
traumatic brain injury; cardiac disorders; electrocardiography; cardiac arrhythmias; the index of cardio-electrophysiological balance; CARDIAC ELECTROPHYSIOLOGICAL BALANCE; ELECTROCARDIOGRAPHIC ABNORMALITIES; RISK-FACTORS; ARRHYTHMIAS; INDEX; ANGLE; PROLONGATION; BIOMARKER; ICEB;
D O I
10.3390/ijerph17228653
中图分类号
X [环境科学、安全科学];
学科分类号
08 ; 0830 ;
摘要
Background: Traumatic brain injury (TBI) is commonly associated with cardiac dysfunction, which may be reflected by abnormal electrocardiograms (ECG) and/or contractility. TBI-related cardiac disorders depend on the type of cerebral injury, the region of brain damage and the severity of the intracranial hypertension. Decompressive craniectomy (DC) is commonly used to reduce intra-cranial hypertension (ICH). Although DC decreases ICH rapidly, its effect on ECG has not been systematically studied. The aim of this study was to analyze the changes in ECG in patients undergoing DC. Methods: Adult patients without previously known cardiac diseases treated for isolated TBI with DC were studied. ECG variables, such as: spatial QRS-T angle (spQRS-T), corrected QT interval (QTc), QRS and T axes (QRS(ax) and T-ax, respectively), STJ segment and the index of cardio-electrophysiological balance (iCEB) were analyzed before DC and at 12-24 h after DC. Changes in ECG were analyzed according to the occurrence of cardiac arrhythmias and 28-day mortality. Results: 48 patients (17 female and 31 male) aged 18-64 were studied. Intra-cranial pressure correlated with QTc before DC (p < 0.01, r = 0.49). DC reduced spQRS-T (p < 0.001) and QTc interval (p < 0.01), increased Tax (p < 0.01) and changed STJ in a majority of leads but did not affect QRS(ax) and iCEB. The iCEB was relatively increased before DC in patients who eventually experienced cardiac arrhythmias after DC (p < 0.05). Higher post-DC iCEB was also noted in non-survivors (p < 0.05), although iCEB values were notably heart rate-dependent. Conclusions: ICP positively correlates with QTc interval in patients with isolated TBI, and DC for relief of ICH reduces QTc and spQRS-T. However, DC might also increase risk for life-threatening cardiac arrhythmias, especially in ICH patients with notably prolonged QTc before and increased iCEB after DC.
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页码:1 / 15
页数:15
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