颅内压监测指标预测闭合性颅脑创伤预后的价值

doi:10.19854/j.cnki.1008-2425.2023.04.0009

摘要/Abstract

摘要： 目的探讨颅内压监测指标预测闭合性颅脑创伤患者预后的价值。方法选取2020年1月至2022年1月本院收治的108例急性闭合性创伤性脑损伤(TBI)患者。按照出院时格拉斯哥预后量表(GOS)评分,其中44例患者预后不良。用颅内压监护仪监测患者入住重症监护室期间的颅内压相关指标,包括颅内压、波幅、压力波幅相关指数、压力反应指数、脑灌注压。用Logstic多因素模型分析不良预后的影响因素。用受试者工作特征曲线(ROC)分析各指标预测不良预后的价值。结果多因素分析结果显示,脑疝(OR=2.401)、合并脑挫伤(OR=1.341)、合并蛛网膜下腔出血(OR=2.102)、去骨瓣减压术(OR=2.923)、颅内压(OR=3.701)、波幅(OR=1.212)、和压力反应指数(OR=2.539)是不良预后的危险因素,而脑灌注压(OR=0.799)是保护性因素。ROC曲线分析结果显示,颅内压、波幅、压力反应指数、脑灌注压预测闭合性TBI患者不良预后的曲线下面积分别为0.741、0.612、0.613、0.780。结论颅内压监测指标对闭合性TBI患者的预后有一定预测价值。

关键词: 颅内压, 闭合性颅脑损伤, 创伤, 预后

Abstract: Objective To explore the value of intracranial pressure monitoring indicators in predicting the prognosis of patients with closed head trauma.Methods A total of 108 patients with acute closed traumatic brain injury (TBI) admitted to our hospital from January 2020 to January 2022 were selected.According to the Glasgow Outcome Scale (GOS) score at discharge,44 patients had poor prognosis.The intracranial pressure monitor was used to monitor the intracranial pressure-related indicators of patients during their admission to the intensive care unit,including intracranial pressure,amplitude,pressure amplitude-related index,stress response index,and cerebral perfusion pressure.Logstic multivariate model was used to analyze the influencing factors of poor prognosis.The receiver operating characteristic curve (ROC) was used to analyze the value of each index in predicting poor prognosis.Results Multivariate analysis showed that brain herniation (OR=2.401),Combined with brain contusion (OR=1.341),combined with subarachnoid hemorrhage (OR=2.102),decompressive craniectomy (OR=2.923),intracranial pressure (OR=3.701),amplitude (OR=1.212),and stress response index (OR=2.539) was a risk factor for poor prognosis,while cerebral perfusion pressure (OR=0.799) was a protective factor.The results of ROC curve analysis showed that the areas under the curve of intracranial pressure,amplitude,stress response index,and cerebral perfusion pressure for predicting poor prognosis in patients with closed TBI were 0.741,0.612,0.613,and 0.780,respectively.Conclusion Intracranial pressure monitoring indicators have certain predictive value for the prognosis of patients with closed TBI.

Key words: Intracranial pressure, Closed head injury, Trauma, Prognosis

中图分类号:

R651

黄弋洋, 李浩, 毛磊, 雷军. 颅内压监测指标预测闭合性颅脑创伤预后的价值[J]. 立体定向和功能性神经外科杂志, 2023, 36(4): 237-241.

Huang Yiyang, Li Hao, Mao Lei, et al. The value of intracranial pressure monitoring indicators in predicting the prognosis of closed traumatic brain injury[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2023, 36(4): 237-241.

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