动态监测BIS、NLR及Copeptin对ASCOP转归的评估价值  

Dynamic testing of the significance of BIS,NLR and Copeptin for prognostic outcome in patients with acute severe carbon monoxide poisoning

作　　者：周萍萍 王乐[1] 王岩[1] 叶艳巧[1] 刘永建[1] ZHOU Pingping;WANG Le;WANG Yan;YE Yanqiao;LIU Yongjian(Department of Emergency Medicine,Harrison International Peace Hospital Affiliated to Hebei Medical University,Hengshui 053000,Hebei,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,河北衡水053000

出　　处：《西部医学》2022年第10期1522-1526,共5页Medical Journal of West China

基　　金：2020年度河北省医学科学研究重点课题(20200405)。

摘　　要：目的探讨动态监测脑电双频指数(BIS)、中性粒细胞/淋巴细胞比值(NLR)及和肽素(Copeptin)对急性重度一氧化碳中毒(ASCOP)患者转归的评估价值。方法选取2018年10月~2021年2月本院收治的ASCOP患者157例。根据患者出院后6个月病情转归分成痊愈组(82例)、迟发性脑病组(DEACMP组,51例)和死亡组(24例)。分别于入院后24 h、3 d、5 d,检测肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、可溶性生长刺激表达基因2蛋白(sST2)、Copeptin、NLR、BIS变化。结果3组患者性别、年龄之间比较,差异无统计学意义(P>0.05)。3组之间接触一氧化碳时间、首次高压氧治疗后清醒时间及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分之间比较,差异均有统计学意义(P<0.05)。入院后24 h、3 d、5 d,3组的cTnI、CK-MB、sST2、Copeptin、NLR、BIS相比,差异均有统计学意义(P<0.05),3组在同一时间点的cTnI、CK-MB、sST2、Copeptin、NLR、BIS相比,差异均有统计学意义(P<0.05)。3组cTnI、CK-MB、sST2、Copeptin、NLR、BIS的变化趋势比较,差异有统计学意义(P<0.05)。相关性分析发现APACHE评分与BIS呈负相关(r=-0.824,P<0.004),与NLR、Copeptin呈正相关(r=0.913,P<0.006;r=0.859,P<0.006)。ROC结果显示,入院后24 h的BIS、NLR、Copeptin联合检测曲线下面积高于入院后3 d及5 d的BIS、NLR、Copeptin联合检测曲线下面积。结论入院后24 h BIS、NLR、Copeptin联合检测对ASCOP患者转归有早期预测价值。Objective To explore the clinical significance of BIS,NLR and Copeptin for prognostic outcome in patients with acute severe carbon monoxide poisoning(ASCOP).Methods 157 ASCOP patients occurred from October 2018 to February 2021 were divided into cure group(82),delayed encephalopathy group(DEACMP)(51)and death group(24).Changes in high-sensitive troponin I(hs-TnI),creatine kinase isoenzyme(CK-MB),soluble growth stimulus expression gene 2 protein(sST2),and peptidoginin(Copeptin),N L R,and B I S values were examined at 24 h,3 d,5 d,after discharge from the hospital admission.Results Comparison between sex,age in the cure,DEACMP,and death groups showed no statistical difference between groups(P>0.05).Comparisons between CO monoxide exposure,coma,and acute physiology and chronic health score system(APACHEⅡ)scores were statistically significant(P<0.05).The hs-TnI,CK-MB,Copeptin,sST2,NLR,BIS values 24 h,3 d,5 d in the cure,DEACMP and death groups were statistically significant(P<0.05).The cure DEACMP,and death groups,compared the change trends in hs-TnI,CK-MB,Copeptin,sST2,NLR,BIS values,with statistically significant differences(P<0.05).The APACHE score was negatively correlated with BIS values(r=-0.781,P<0.004)and a positive correlation with NLR(r=0.737,P<0.006).The results using the receiver operating characteristic curve(ROC)showed that the area under the 24 h,BIS,NLR joint detection curve after admission was 0.829,with the greatest predictive value for outcome in ASCOP patients.Conclusion Dynamic detection of BIS and NLR has important clinical value for early prediction of prognostic outcome in ASCOP patients.

关 键 词：急性重度一氧化碳中毒 中性粒细胞/淋巴细胞比值 脑电双频指数 和肽素 迟发性脑病 

分 类 号：R466.1[医药卫生—临床医学]