Objective:To investigate the influening factors for postoperative paroxysmal sympathetic hyperactivity (PSH) and prolonged disorders of consciousness (pDoC) in patients with severe traumatic brain injury (sTBI).Methods:A retrospective cross-sectional study was performed; 204 patients with sTBI accepted surgery in Department of Neurosurgery, Second Affiliated Hospital of Fuyang Normal University from January 2018 to April 2024 were enrolled. These patients were divided into PSH group and non-PSH group based on postoperative PSH occurrence. These patients were also divided into pDoC group and non-pDoC group depending on whether duration of postoperative pDoC exceeded 28 days. Differences in clinical data between the PSH group and non-PSH group, as well as between the pDoC group and non-pDoC group, were compared respectively. Multivariate Logistic regression analysis was used to determine the independent influencing factors for PSH or pDoC. Receiver operating characteristic curve was used to investigate the predictive value of these influencing factors in PSH or pDoC in patients with sTBI.Results:(1) Of these 204 patients with sTBI, 28 patients (13.7 %) experienced PSH and 176 patients (86.3 %) were without PSH; compared with the non-PSH group, the PSH group had younger age, lower Glasgow Coma Scale (GCS) score on admission, higher proportions of patients with brain herniation, basilar skull fracture and traumatic intraventricular hemorrhage, higher proportion of patients accepted decompressive craniectomy, higher blood glucose level and neutrophil-to-lymphocyte ratio (NLR), and higher proportion of patients with postoperative hydrocephalus, with significant differences ( P<0.05). Of these 204 patients with sTBI, 77 patients (37.7 %) suffered from pDoC, and 127 (62.3 %) were without pDoC; compared with the non-pDoC group, the pDoC group had older age, lower GCS score on admission, higher proportions of patients with brain herniation, basilar skull fracture and traumatic intraventricular hemorrhage, higher proportion of patients accepted decompressive craniectomy, and higher proportions of patients with postoperative hydrocephalus or postoperative PSH, with significant differences ( P<0.05). (2) Multivariate Logistic regression analysis showed that age, skull base fracture, traumatic intraventricular hemorrhage, blood glucose level, NLR, and postoperative hydrocephalus were independent influencing factors for PSH ( P<0.05); PSH, age, GCS score on admission, and postoperative hydrocephalus were independent influencing factors for pDoC ( P<0.05). (3) Areas under the curve (AUC) of age, skull base fracture, traumatic intraventricular hemorrhage, blood glucose level, NLR and postoperative hydrocephalus in predicting PSH were 0.750, 0.718, 0.760, 0.756, 0.790 and 0.679, respectively; AUC of age, GCS score on admission, postoperative hydrocephalus, postoperative PSH and their combinations in predicting pDoC were 0.598, 0.833, 0.691, 0.630 and 0.925, respectively. Conclusion:The sTBI patients with younger age, skull base fracture, traumatic intraventricular hemorrhage, high blood glucose level and NLR, or hydrocephalus are prone to have postoperative PSH; the sTBI patients with older age, low GCS score on admission, postoperative hydrocephalus or postoperative PSH are prone to have postoperative pDoC.

Objective:To investigate the influening factors for postoperative paroxysmal sympathetic hyperactivity (PSH) and prolonged disorders of consciousness (pDoC) in patients with severe traumatic brain injury (sTBI).Methods:A retrospective cross-sectional study was performed; 204 patients with sTBI accepted surgery in Department of Neurosurgery, Second Affiliated Hospital of Fuyang Normal University from January 2018 to April 2024 were enrolled. These patients were divided into PSH group and non-PSH group based on postoperative PSH occurrence. These patients were also divided into pDoC group and non-pDoC group depending on whether duration of postoperative pDoC exceeded 28 days. Differences in clinical data between the PSH group and non-PSH group, as well as between the pDoC group and non-pDoC group, were compared respectively. Multivariate Logistic regression analysis was used to determine the independent influencing factors for PSH or pDoC. Receiver operating characteristic curve was used to investigate the predictive value of these influencing factors in PSH or pDoC in patients with sTBI.Results:(1) Of these 204 patients with sTBI, 28 patients (13.7 %) experienced PSH and 176 patients (86.3 %) were without PSH; compared with the non-PSH group, the PSH group had younger age, lower Glasgow Coma Scale (GCS) score on admission, higher proportions of patients with brain herniation, basilar skull fracture and traumatic intraventricular hemorrhage, higher proportion of patients accepted decompressive craniectomy, higher blood glucose level and neutrophil-to-lymphocyte ratio (NLR), and higher proportion of patients with postoperative hydrocephalus, with significant differences ( P<0.05). Of these 204 patients with sTBI, 77 patients (37.7 %) suffered from pDoC, and 127 (62.3 %) were without pDoC; compared with the non-pDoC group, the pDoC group had older age, lower GCS score on admission, higher proportions of patients with brain herniation, basilar skull fracture and traumatic intraventricular hemorrhage, higher proportion of patients accepted decompressive craniectomy, and higher proportions of patients with postoperative hydrocephalus or postoperative PSH, with significant differences ( P<0.05). (2) Multivariate Logistic regression analysis showed that age, skull base fracture, traumatic intraventricular hemorrhage, blood glucose level, NLR, and postoperative hydrocephalus were independent influencing factors for PSH ( P<0.05); PSH, age, GCS score on admission, and postoperative hydrocephalus were independent influencing factors for pDoC ( P<0.05). (3) Areas under the curve (AUC) of age, skull base fracture, traumatic intraventricular hemorrhage, blood glucose level, NLR and postoperative hydrocephalus in predicting PSH were 0.750, 0.718, 0.760, 0.756, 0.790 and 0.679, respectively; AUC of age, GCS score on admission, postoperative hydrocephalus, postoperative PSH and their combinations in predicting pDoC were 0.598, 0.833, 0.691, 0.630 and 0.925, respectively. Conclusion:The sTBI patients with younger age, skull base fracture, traumatic intraventricular hemorrhage, high blood glucose level and NLR, or hydrocephalus are prone to have postoperative PSH; the sTBI patients with older age, low GCS score on admission, postoperative hydrocephalus or postoperative PSH are prone to have postoperative pDoC.

Objective To investigate the effects of controlled low central venous pressure (CLCVP) on cerebral oxygen metabolism during orthotopic liver transplantation (OLT),and study the safety of CLCVP in OLT.Method Forty-six patients subject to OLT were randomly divided into CLCVP group (CL group) and CVP group (C group).Blood samples were taken from radial artery and jugular simultaneously for blood gas analysis before operation (T1,baseline),immediately blocking inferior vena and portal vein (T2),30 min after anhepatic phase (T3),30 min after graft reperfusion (T4),2 h after graft reperfusion (T5),and 24 h after graft reperfusion (T6).Cerebral arterial oxygen content (CaO2),jugular oxygen content (CjvO2),cerebral arterial-venous oxygen content difference (Ca-jvO2),cerebral oxygen extraction rate (CERO2),and cerebral blood flow/ cerebral metabolic rate of oxygen (CBF/CMRO2) were calculated by the Fick formulae.Meanwhile,blood samples were taken from jugular simultaneously for serum creatinine (Cr) and urea nitrogen (BUN) a different time points.We also recorded the whole operation time,anhepatic phase time,volume of blood loss and transfusion,and urine volume.Results As compared with C group,CaO2,CjvO2,Ca-jvO2,SjvO2,CERO2 and CBF/CMRO2 in CL group were nearly not changed at different time pioints (P＞0.05),but in the same group,as compared with T1 and T2,the CaO2,CjvO2,Ca-jvO2 and CERO2 in T3,T4 and T5 were decreased significantly (P＜0.05),and the SjvO2 in T3,T4 and T5 was increased remarkably.The operation time and anhepatic phase time had no significant difference in both groups.As compared with C group,the volume of blood loss and transfusion in CL group were decreased (P＜0.05),and the urine volume in CL group CL was increased significantly (P＜0.05).Cr and BUN showed no significant difference in both groups and at the same time points of C group and CL group.Conclusion CLCVP can decrease volume of blood loss and transfusion,increase urine volume during OLT,and it does not change the cerebral oxygen metabolism during OLT.