早期脑氧利用率联合脑电双频指数对老年急性重度一氧化碳中毒迟发性脑病患者的预测价值  

Predictive value of early cerebral oxygen utilization combined with the bispectral index for delayedencephalopathy after acute carbon monoxide poisoning in elderly patients

作　　者：肖青勉[1] 李佳[1] 刘倩[1] 刘永建[2] 高珣[2] 王璞[2] 王维展[2] Xiao Qingmian;Li Jia;Liu Qian;Liu Yongjian;Gao Xun;Wang Pu;Wang Weizhan(Department of Emergency,Harrison International Peace Hospital of Hebei Medical University,Hengshui 053000,China;Emergency General Ward,Harrison International Peace Hospital of Hebei Medical University,Hengshui 053000,China)

机构地区：[1]河北医科大学哈励逊国际和平医院急救医学部,衡水053000 [2]河北医科大学哈励逊国际和平医院急诊综合病房,衡水053000

出　　处：《中华老年医学杂志》2021年第6期722-726,共5页Chinese Journal of Geriatrics

基　　金：河北省衡水市科学技术研究与发展计划项目(13007Z)。

摘　　要：目的︰研究早期脑氧利用率(O_(2)UCc)与脑电双频指数(BIS)联合监测对老年人重度急性一氧化碳中毒迟发性脑病(DEACMP)预测的临床意义。方法﹐采用回顾性分析方法,选取河北医科大学附属哈励逊国际和平医院急救医学部2018年11月至2020年1月收治的老年急性重度一氧化碳中毒(ASCMP)患者90例为研究对象,依据患者预后分为DEACMP组25例和预后良好组65例,将两组患者旱期不同时刻O_(2)UCc,BIS进行比较,了解O_(2)UCc,BIS与发生DEACMP的相关性,并分析两者单独及联合对发生DEACMP预测的临床意义。结果﹑入院0、6、12、24 h DEACMP组O_(2)UCc高于预后良好组、BTS低于预后良好组,两组差异有统计学意义(均P<0.01)。Pearson相关性分析结果显示,O_(2)UCc与DEACMP呈负相关(r_(0h)=-0.482、r_(6h),=-0.534、r_(12h)=-0.587,r_(24 h)-0.514,均P<0.01);BIS与DEACMP呈正相关(r_(0h)=0.348、r_(6h)=0.583、r_(12h)=0.679、r_(24h)=0.489,均P<0.01),且12 h相关性最强;以12 h时O_(2)UCc,BIS及两者联合为DEACMP的预测因子进行ROC曲线分析,结果显示,O_(2)UCc,BIS及两者联合对DEACMP预测的ROC曲线下面积分别为0.845,0.850和0.909,灵敏度分别为78.5%、90.8%、96.9%,特异度分别为80.0%、76.0%、84.0%。结论早期O_(2)UCc,BIS对预测ASCMP发展为DEACMP有较高的临床价值,两者联合效果更佳。Objective To investigate clinical value of early cerebral oxygen utilization(O_(2)UCc)combined with the bispectral index(BTS)for monitoring delayed encephalopathy after acute carbonmonoxide poisoning(DEACMP)in elderly patients.Methods This was a retrospective analysis.Atotal of 90 elderly patients with acute severe carbon monoxide poisoning(ASCMP)treated in Harrison International Peace Hospital from Nov.2018 to Jan.2020 were considered as research objects.Patientswere divided into the DEACMP group(n=25)and the good prognosis group(n=65)according to theirprognosis.Oxygen quantity absorbed into UCC(O_(2)UCc)and Bispectral index(BIS)at different times inthe early stages were compared between the two groups.Correlations of O_(2)UCc and BIS with theoccurrence of DEACMP were analyzed.Clinical significance of O_(2)UCc or BIS alone and of the twoparameters in combination for the prediction of DEACMP was investigated.Results O_(2)UCc washigher and BIS was lower in the DEACMP group than in the good prognosis group at 0 h,6 h,12 h,and 24 h after admission(all P<0.01).Pearson correlation analysis showed that O_(2)UCc wasnegatively correlated with DEACMP(r_(0h)=0.482,r_(6h),=-0.534,r_(12 h)=-0.587,r_(24 h)=-0.514,all P<0.01),BIS was positively correlated with DEACMP(r_(0h)=0.348,r_(6h),=0.583,r_(12h),=0.679,r_(24h)=0.489,all P<0.01),and the correlation was the strongest at 12h after admission.ROC curveanalysis was performed with O_(2)UCc,BTS and the combined predictors at 12 h,and the results showedthat the areas under the ROC curve of O_(2)UCc,BIS and the two in combination for DEACMP prediction were 0.845,0.850 and 0.909,respectively,the sensitivities were 78.5%,90.8%and 96.9%and the specificities were 80.0%,76.0%and 84.0%,respectively.Conclusions Early detection of O_(2)UCc or BIS has a good clinical value for predicting the development of ASCMP to DEACMP,andtheir combined value is even better.

关 键 词：脑电双频指数 一氧化碳中毒 缺氧 脑 

分 类 号：R595.1[医药卫生—内科学] R747.9[医药卫生—临床医学]