我们要感谢所有在新生儿监护病房工作的同事。

本议定书经上海交通大学医学院济医院机构审查委员会批准. 
 1. 病人的准备 注意: ICP 传感器由手术操作 ( 图 1 ) 放置在患者中。该传感器被放置在硬膜外间隙, 硬膜下间隙, 薄壁, 或心室系统. 
<ol> <li> 通过特定的通信电缆将 ICP 监视设备与床边显示器连接. </li>
	<li> 调整病人和 #39 的床边监控器的参考, 使床边监测器的数据与 ICP 监测机相符. </li>
	<li> 在患者和 #39 的左侧或右侧桡动脉上执行动脉行位置 20 . </li>
	<li> 将动脉线与感受连接. </li>
	<li> 通过通信电缆将压力传感器与患者和 #39 的床头显示器连接起来. </li>
	<li> 零调整床边显示器, 使测量血压与实际值重合. </li>
</ol> 2。生理参数的记录 <ol> <li> 通过网线将患者和 #39 的床边显示器与数据收集和存储设备连接起来. </li>
	<li> 按电源按钮打开数据收集设备. </li>
	<li> 等待几秒钟, 直到多模态监控软件自动运行. </li>
	<li> 输入患者的信息, 包括名称、ID、诊断和初始格拉斯哥昏迷量表 (GCS). </li>
	<li> 单击 #34; 保存并启动监视和 #34; 按钮以启动数据收集和存储. </li>
	<li> 单击 #34; 在数据获取结束时在屏幕上关闭和 #34; 按钮 ( 图 2 ). </li>
	<li> 输入最终的 gc. </li>
</ol> 3。参数分析 <ol> <li> 通过主机上的通用串行总线 (USB) 接口将存储的数据转储到 U 磁盘. </li>
	<li> 输入用户名和密码以登录到分析服务器. </li>
	<li> 单击并 #34; 创建新的记录和 #34; 按钮, 然后在 u盘中选择数据文件以开始上载. </li>
	<li> 在分析数据之前等待大约10到20分钟 (取决于数据大小). </li>
	<li> 单击 #34;D etail 和 #34; 每个记录的按钮以查看结果. </li>
	<li> 单击 #34; 图表查看和 #34; 查看最终的图表. </li>
	<li> 拖动时间线以查看更多详细信息. </li>
	<li> 单击 #34; scattergram 和 #34; 按钮可查看参数的分布. </li>
</ol>

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本文的目的是介绍一种新型的神经外科危重患者综合监测分析系统, 用于监测生理参数, 分析当前临床状况, 希望预测预后神经外科危重患者。目前, icp 监测的重点主要是平均 icp 值, 而忽略其他参数, 这可能会带来不准确或延迟的风险4,5,21。另一方面, icp 波形、放大器、RAP、PRx 和审咨委等衍生参数在预测预后和指导正确治疗方?...

ICP 监测被广泛用于评价神经外科的颅内状态, 尤其是神经外科危重患者1,2,3。除了平均 icp 值外, icp 波形、放大器、RAP、PRx、审咨委等等参数均可反映脑循环状态、脑脊液代偿性储备和大脑顺应4、5、6,7,8,9,10,11,12,13. 他们可以预示着即将到来的神经恶化, 甚至病人的结果14,15,16,17,18。它们也可以作为正确处理19的指导。然而, 大多数临床医生只关注的平均 ICP 值, 而忽略这些参数。这部分是因为在日常临床工作中, 很少有适合临床医生使用的特定设备。
为了解决这些弊端, 我们最近开发了一个多模监控系统。我们使用自动数据收集和存储设备, 以不断获取病人的生理信息, 如血压, ICP, 和氧饱和度, 并分析这些生理参数, 以揭示目前的临床状况,希望能预测神经外科危重患者的预后。该多模态监测系统具有以下几个优点: (1) 能在高频采集 real-time 数据, (2) 可记录多个参数,即、ICP 波形、PRx、RAP 和审咨委, (3) 可实现长期连续监测, (4)它是便携的, 易于学习。
因此, 本文的目的是显示一个详细的方法如何使用多学科监测系统记录各种生理参数的神经外科危重患者。

<table><tbody><tr><td>Bedside monitor</td><td>Philips</td><td>IntelliVue MP40 M8003A</td><td>With interfacing module</td></tr><tr><td>ICP monitoring machine</td><td>&amp;nbsp;Johnson &amp;amp; Johnson or Sophysa</td><td></td><td></td></tr><tr><td>Arterial cannula</td><td>BD</td><td>REF682245</td><td></td></tr><tr><td>Pressure transducer</td><td>Haisheng Medical</td><td>DBPT-0103</td><td></td></tr><tr><td>Data collection device</td><td>Shanghai Haoju</td><td>Neumatic</td><td></td></tr><tr><td>Computer</td><td></td><td></td><td>Requires Windows operating system</td></tr></tbody></table>

a detailed protocol for physiological parameters acquisition and analysis in neurosurgical critical patients

颅内压力 (ICP) 监测是目前广泛应用于神经外科危重患者。除了平均 icp 值外, icp 波形、脉冲振幅、icp 振幅与 icp 平均值 (RAP)、压力反应性指数 (PRx)、icp 和动脉血压 (基地) 波幅相关 (审咨委) 等相关参数上, 可以反映颅内状态, 预测预后, 也可作为正确治疗的指导。然而, 大多数临床医生只关注的平均 ICP 值, 而忽略这些参数, 因为目前的设备的局限性。我们最近开发了一个综合的监控系统来解决这些弊端。这种便携式的 user-friendly 系统将使用数据采集和存储装置, 以持续地获取患者的生理参数,即: 即、基地、ICP 和氧饱和度, 然后分析这些生理参数。希望将多学科监护系统作为监测生理参数的关键措施, 分析当前临床状况, 预测神经外科危重患者的预后。

这一新的多学科监测系统应用于22神经外科危重患者 (15 男性)。其中12人 (54.55%) 患有外伤性脑损伤, 其中 9 (40.91%) 有颅内出血, 1 (4.55%) 有严重脑梗塞。总监测时间超过1900小时 (约88小时每名患者)。手术成功后, 我们不断监测和分析他们的 ICP、BP、CPP、PRx、说唱和审咨委。图 3显示了来自该监视系统的代表性数据。我们可以调整时间线以查看更详细的信?...

Watch this Scientific Journal Video about A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients at JoVE.com

A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients

最近, 我们开发了一个便携式多学科监测系统, 监测各种生理参数的神经外科危重患者。介绍了如何使用这种多模态监控系统的详细协议。

神经外科危重患者生理参数采集与分析的详细方案

Intracranial pressure (ICP) monitoring is now widely used in neurosurgical critical patients. Besides mean ICP value, the ICP derived parameters such as ...

a-detailed-protocol-for-physiological-parameters-acquisition-analysis

Research

JoVE Journal

Medicine

7.0K 次观看.  Shanghai Jiaotong University School of Medicine. 最近, 我们开发了一个便携式多学科监测系统, 监测各种生理参数的神经外科危重患者。介绍了如何使用这种多模态监控系统的详细协议。

视频: A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients

Intra-Operative Behavioral Tasks in Awake Humans Undergoing Deep Brain Stimulation Surgery

Deep brain stimulation (DBS) is a surgical procedure that directs chronic, high frequency electrical stimulation to specific targets in the brain through implanted electrodes. Deep brain stimulation was first implemented as a therapeutic modality by Benabid et al. in the late 1980s, when he used this technique to stimulate the ventral intermediate nucleus of the thalamus for the treatment of tremor 1. Currently, the procedure is used to treat patients who fail to respond adequately to medical management for diseases such as Parkinson's, dystonia, and essential tremor. The efficacy of this procedure for the treatment of Parkinson's disease has been demonstrated in well-powered, randomized controlled trials 2. Presently, the U.S. Food and Drug Administration has approved DBS as a treatment for patients with medically refractory essential tremor, Parkinson's disease, and dystonia. Additionally, DBS is currently being evaluated for the treatment of other psychiatric and neurological disorders, such as obsessive compulsive disorder, major depressive disorder, and epilepsy. 
DBS has not only been shown to help people by improving their quality of life, it also provides researchers with the unique opportunity to study and understand the human brain. Microelectrode recordings are routinely performed during DBS surgery in order to enhance the precision of anatomical targeting. Firing patterns of individual neurons can therefore be recorded while the subject performs a behavioral task. Early studies using these data focused on descriptive aspects, including firing and burst rates, and frequency modulation 3. More recent studies have focused on cognitive aspects of behavior in relation to neuronal activity 4,5. This article will provide a description of the intra-operative methods used to perform behavioral tasks and record neuronal data with awake patients during DBS cases. Our exposition of the process of acquiring electrophysiological data will illuminate the current scope and limitations of intra-operative human experiments.

Deep brain stimulation surgery offers a unique opportunity to examine information encoding in the awake human brain. This article will describe intra-operative methods used to perform cognitive and behavioral tasks while simultaneously acquiring physiological data such as EMG, single-unit neuronal activity and/or local field potentials.

在接受深部脑刺激手术术中唤醒人类行为任务

Deep brain stimulation (DBS) is a surgical procedure that directs chronic, high frequency electrical stimulation to specific targets in the brain through ...

科研

医学

Performing Behavioral Tasks in Subjects with Intracranial Electrodes

Patients having stereo-electroencephalography (SEEG) electrode, subdural grid or depth electrode implants have a multitude of electrodes implanted in different areas of their brain for the localization of their seizure focus and eloquent areas. After implantation, the patient must remain in the hospital until the pathological area of brain is found and possibly resected. During this time, these patients offer a unique opportunity to the research community because any number of behavioral paradigms can be performed to uncover the neural correlates that guide behavior. Here we present a method for recording brain activity from intracranial implants as subjects perform a behavioral task designed to assess decision-making and reward encoding. All electrophysiological data from the intracranial electrodes are recorded during the behavioral task, allowing for the examination of the many brain areas involved in a single function at time scales relevant to behavior. Moreover, and unlike animal studies, human patients can learn a wide variety of behavioral tasks quickly, allowing for the ability to perform more than one task in the same subject or for performing controls. Despite the many advantages of this technique for understanding human brain function, there are also methodological limitations that we discuss, including environmental factors, analgesic effects, time constraints and recordings from diseased tissue. This method may be easily implemented by any institution that performs intracranial assessments; providing the opportunity to directly examine human brain function during behavior.

Patients implanted with intracranial electrodes provide a unique opportunity to record neurological data from multiple areas of the brain while the patient performs behavioral tasks. Here, we present a method of recording from implanted patients that can be reproducible at other institutions with access to this patient population.

执行任务的行为与颅内电极主题

Patients having stereo-electroencephalography (SEEG) electrode, subdural grid or depth electrode implants have a multitude of electrodes implanted in ...

行为学

Combined Invasive Subcortical and Non-invasive Surface Neurophysiological Recordings for the Assessment of Cognitive and Emotional Functions in Humans

In spite of the success in applying non-invasive electroencephalography (EEG), magneto-encephalography (MEG) and functional magnetic resonance imaging (fMRI) for extracting crucial information about the mechanism of the human brain, such methods remain insufficient to provide information about physiological processes reflecting cognitive and emotional functions at the subcortical level. In this respect, modern invasive clinical approaches in humans, such as deep brain stimulation (DBS), offer a tremendous possibility to record subcortical brain activity, namely local field potentials (LFPs) representing coherent activity of neural assemblies from localized basal ganglia or thalamic regions. Notwithstanding the fact that invasive approaches in humans are applied only after medical indication and thus recorded data correspond to altered brain circuits, valuable insight can be gained regarding the presence of intact brain functions in relation to brain oscillatory activity and the pathophysiology of disorders in response to experimental cognitive paradigms. In this direction, a growing number of DBS studies in patients with Parkinson&#39;s disease (PD) target not only motor functions but also higher level processes such as emotions, decision-making, attention, memory and sensory perception. Recent clinical trials also emphasize the role of DBS as an alternative treatment in neuropsychiatric disorders ranging from obsessive compulsive disorder (OCD) to chronic disorders of consciousness (DOC). Consequently, we focus on the use of combined invasive (LFP) and non-invasive (EEG) human brain recordings in assessing the role of cortical-subcortical structures in cognitive and emotional processing trough experimental paradigms (e.g. speech stimuli with emotional connotation or paradigms of cognitive control such as the Flanker task), for patients undergoing DBS treatment.

The present protocol aims at assessing cognitive-emotional functions in the basal ganglia by simultaneous neurophysiological recording of local field potentials and non-invasive brain cortical activity (EEG). The procedure is exemplified by the use of paradigms involving speech stimuli with emotional connotation or the Flanker task involving cognitive control.

在人类联合微创皮层下和非侵入性的表面神经生理学录音认知的评估和情感作用

In spite of the success in applying non-invasive electroencephalography (EEG), magneto-encephalography (MEG) and functional magnetic resonance imaging ...

Simultaneous Recordings of Cortical Local Field Potentials, Electrocardiogram, Electromyogram, and Breathing Rhythm from a Freely Moving Rat

Monitoring the physiological dynamics of the brain and peripheral tissues is necessary for addressing a number of questions about how the brain controls body functions and internal organ rhythms when animals are exposed to emotional challenges and changes in their living environments. In general experiments, signals from different organs, such as the brain and the heart, are recorded by independent recording systems that require multiple recording devices and different procedures for processing the data files. This study describes a new method that can simultaneously monitor electrical biosignals, including tens of local field potentials in multiple brain regions, electrocardiograms that represent the cardiac rhythm, electromyograms that represent awake/sleep-related muscle contraction, and breathing signals, in a freely moving rat. The recording configuration of this method is based on a conventional micro-drive array for cortical local field potential recordings in which tens of electrodes are accommodated, and the signals obtained from these electrodes are integrated into a single electrical board mounted on the animal's head. Here, this recording system was improved so that signals from the peripheral organs are also transferred to an electrical interface board. In a single surgery, electrodes are first separately implanted into the appropriate body parts and the target brain areas. The open ends of all of these electrodes are then soldered to individual channels of the electrical board above the animal's head so that all of the signals can be integrated into the single electrical board. Connecting this board to a recording device allows for the collection of all of the signals into a single device, which reduces experimental costs and simplifies data processing, because all data can be handled in the same data file. This technique will aid the understanding of the neurophysiological correlates of the associations between central and peripheral organs.

This study introduces a method for the simultaneous recording of local field potentials in the brain, electrocardiograms, electromyograms, and breathing signals of a freely moving rat. This technique, which reduces experimental costs and simplifies data analysis, will contribute to the understanding of the interactions between the brain and peripheral organs.

自由运动大鼠皮质局部电位、心电图、肌电图和呼吸节律的同步记录

Monitoring the physiological dynamics of the brain and peripheral tissues is necessary for addressing a number of questions about how the brain controls ...

神经科学

A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury

Intracranial pressure (ICP) monitoring is a cornerstone of the intensive care management of patients with severe acute brain injuries, including traumatic brain injury. While elevations in ICP are common, data regarding the measurement and treatment of these ICP elevations are conflicting. There is increasing recognition that changes in the balance between supply and demand of brain tissue are critically important and therefore the measurement of multiple modalities is required. Approaches are not standard, and therefore this article provides a description of a bedside, single burr hole approach to multimodality monitoring that allows the passage of probes designed to measure not only ICP but brain tissue oxygen, blood flow, and intracranial electroencephalography. Patient selection criteria, operative procedures, and practical considerations for securing probes during critical care are described. This method is readily performed, safe, secure, and flexible for the adoption of a variety of multimodality monitoring approaches aimed at detecting or preventing secondary brain injuries.

A method of recording multimodality monitoring signals in patients with severe brain injuries using a bedside, single burr hole technique is described.

一种用于重型颅脑损伤多模态监测的床边单毛刺孔方法

Intracranial pressure (ICP) monitoring is a cornerstone of the intensive care management of patients with severe acute brain injuries, including traumatic ...

Standardized Hemorrhagic Shock Induction Guided by Cerebral Oximetry and Extended Hemodynamic Monitoring in Pigs

Hemorrhagic shock ranks among the main reasons for severe injury-related death. The loss of circulatory volume and oxygen carriers can lead to an insufficient oxygen supply and irreversible organ failure. The brain exerts only limited compensation capacities and is particularly at high risk of severe hypoxic damage.This article demonstrates the reproducible induction of life-threatening hemorrhagic shock in a porcine model by means of calculated blood withdrawal. We titrate shock induction guided by near-infrared spectroscopy&#160;and extended hemodynamic monitoring to display systemic circulatory failure, as well as cerebral microcirculatory oxygen depletion. In comparison to similar models that primarily focus on predefined removal volumes for shock induction, this approach highlights a titration by means of the resulting failure of macro- and microcirculation.

Hemorrhagic shock is a severe complication in seriously injured patients, which leads to life-threatening oxygen undersupply. We present a standardized method to induce hemorrhagic shock via blood withdrawal in pigs that is guided by hemodynamics and microcirculatory cerebral oxygenation.

由脑氧测量和猪期扩展血液动力学监测指导的标准化出血性休克诱导

Hemorrhagic shock ranks among the main reasons for severe injury-related death. The loss of circulatory volume and oxygen carriers can lead to an ...

Reliable Acquisition of Electroencephalography Data during Simultaneous Electroencephalography and Functional MRI

Simultaneous electroencephalography (EEG) and functional magnetic resonance imaging (fMRI), EEG-fMRI, combines the complementary properties of scalp EEG (good temporal resolution) and fMRI (good spatial resolution) to measure neuronal activity during an electrographic event, through hemodynamic responses known as blood-oxygen-level-dependent (BOLD) changes. It is a non-invasive research tool that is utilized in neuroscience research and is highly beneficial to the clinical community, especially for the management of neurological diseases, provided that proper equipment and protocols are administered during data acquisition. Although recording EEG-fMRI is apparently straightforward, the correct preparation, especially in placing and securing the electrodes, is not only important for safety but is also critical in ensuring the reliability and analyzability of the EEG data obtained. This is also the most experience-demanding part of the preparation. To address these issues, a straightforward protocol that ensures data quality was developed. This article provides a step-by-step guide for acquiring reliable EEG data during EEG-fMRI using this protocol that utilizes readily available medical products. The presented protocol can be adapted to different applications of EEG-fMRI in research and clinical settings, and may be beneficial to both inexperienced and expert operators.

This article provides a straightforward protocol for acquiring good quality electroencephalography (EEG) data during simultaneous EEG and functional magnetic resonance imaging by utilizing readily available medical products.

同时脑电图和功能 MRI 期间的可靠脑成像数据获取

Simultaneous electroencephalography (EEG) and functional magnetic resonance imaging (fMRI), EEG-fMRI, combines the complementary properties of scalp EEG ...

How to Administer Near-Infrared Spectroscopy in Critically ill Neonates, Infants, and Children

Near infrared spectroscopy (NIRS) calculates regional tissue oxygenation (rSO2) using the different absorption spectra of oxygenated and deoxygenated hemoglobin molecules. A probe placed on the skin emits light that is absorbed, scattered, and reflected by the underlying tissue. Detectors in the probe sense the amount of reflected light: this reflects the organ-specific ratio of oxygen supply and consumption - independent of pulsatile flow. Modern devices enable the simultaneous monitoring at different body sites. A rise or dip in the rSO2 curve visualizes changes in oxygen supply or demand before vital signs indicate them. The evolution of rSO2 values in relation to the starting point is more important for interpretation than are absolute values.
A routine clinical application of NIRS is the surveillance of somatic and cerebral oxygenation during and after cardiac surgery. It is also administered in preterm infants at risk for necrotizing enterocolitis, newborns with hypoxic ischemic encephalopathy and a potential risk of impaired tissue oxygenation. In the future, NIRS could be increasingly used in multimodal neuromonitoring, or applied to monitor patients with other conditions (e.g., after resuscitation or traumatic brain injury).

This protocol is designed to assist clinicians to measure regional tissue oxygenation at different body sites in infants and children. It can be used in situations where tissue oxygenation is potentially compromised, particularly during cardiopulmonary bypass, when using non-pulsatile cardiac-assist devices, and in critically ill neonates, infants and children.

如何管理危重新生儿、婴儿和儿童近红外光谱

Near infrared spectroscopy (NIRS) calculates regional tissue oxygenation (rSO2) using the different absorption spectra of oxygenated and deoxygenated ...

Real-Time Monitoring of Neurocritical Patients with Diffuse Optical Spectroscopies

Neurophysiological monitoring is an important goal in the treatment of neurocritical patients, as it may prevent secondary damage and directly impact morbidity and mortality rates. However, there is currently a lack of suitable non-invasive, real-time technologies for continuous monitoring of cerebral physiology at the bedside. Diffuse optical techniques have been proposed as a potential tool for bedside measurements of cerebral blood flow and cerebral oxygenation in case of neurocritical patients. Diffuse optical spectroscopies have been previously explored to monitor patients in several clinical scenarios ranging from neonatal monitoring to cerebrovascular interventions in adults. However, the feasibility of the technique to aid clinicians by providing real-time information at the bedside remains largely unaddressed. Here, we report the translation of a diffuse optical system for continuous real-time monitoring of cerebral blood flow, cerebral oxygenation, and cerebral oxygen metabolism during intensive care. The real-time feature of the instrument could enable treatment strategies based on patient-specific cerebral physiology rather than relying on surrogate metrics, such as arterial blood pressure. By providing real-time information on the cerebral circulation at different time scales with relatively cheap and portable instrumentation, this approach may be especially useful in low-budget hospitals, in remote areas and for&#160;monitoring in open fields (e.g., defense and sports).

Presented here is a protocol for non-invasively monitoring cerebral hemodynamics of neurocritical patients in real-time and at the bedside using diffuse optics. Specifically, the proposed protocol uses a hybrid diffuse optical systems to detect and display real-time information on cerebral oxygenation, cerebral blood flow and cerebral metabolism.

使用漫反射光谱实时监测神经危重症患者

Neurophysiological monitoring is an important goal in the treatment of neurocritical patients, as it may prevent secondary damage and directly impact ...

Intra-Abdominal Pressure Measurements in Neurocritical Patients

Intra-abdominal pressure (IAP) is increasingly being recognized as an indispensable and significant physiological parameter in intensive care units (ICU). IAP has been measured in a variety of ways with the development of many techniques in recent years. The level of intra-abdominal pressure under normal conditions is generally equal to or less than 12 mmHg. Accordingly, abdominal hypertension (IAH) is defined as two consecutive IAP measurements higher than 12 mmHg within 4-6 h. When IAH deteriorates further with IAP higher than 20 mmHg along with organ dysfunction and/or failure, this clinical manifestation can be diagnosed as abdominal compartment syndrome (ACS). IAH and ACS are associated with gastrointestinal ischemia, acute renal failure, and lung injury, leading to severe morbidity and mortality. Elevated IAP and IAH may affect the cerebral venous return and outflow of the cerebrospinal fluid by increasing the intrathoracic pressure (ITP), ultimately leading to increased intracranial pressure (ICP). Therefore, it is essential to monitor IAP in critically ill patients. The reproducibility and accuracy of intra-bladder pressure (IBP) measurements in previous studies need to be further improved, although the indirect measurement of IAP is now a widely used technique. To address these limitations, we recently used a set of IAP monitoring systems with advantages of convenience, continuous monitoring, digital visualization, and long-term IAP recording and data storage in critically ill patients. This IAP monitoring system can detect intra-abdominal hypertension and potentially analyze clinical status in real time. The recorded IAP data and other physiological indicators, such as intracranial pressure, can be further used for correlation analysis to guide treatment and predict a patient&#39;s possible prognosis.

<meta charset="utf8"></head><body>神经危重症患者的腹内压测量

This protocol details the use of a set of intra-abdominal pressure monitoring systems with advantages of convenience, continuous monitoring, digital visualization, and long-term IAP recording and data storage in neurocritical patients to detect intra-abdominal hypertension, which is used for correlation analysis to guide treatment and predict prognoses.

神经危重症患者的腹内压测量

Intra-abdominal pressure (IAP) is increasingly being recognized as an indispensable and significant physiological parameter in intensive care units (ICU). ...