动静脉氧压差、血清MIF水平预测重型颅脑损伤患者近期死亡风险价值研究  

The value of arterial-venous oxygen pressure difference and serum macrophage migration inhibitory factor level in predicting the recent deathin patients with severe head injury

作　　者：赵晶晶 王雅宁[1] 王海民 孙晓雨 ZHAO Jingjing;WANG Yaning;WANG Haimin;SUN Xiaoyu(Department of Critical Care Medicine,First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院重症医学科,河北张家口075000

出　　处：《中国急救复苏与灾害医学杂志》2023年第1期42-45,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：2018年度河北省医学科学研究重点课题计划(编号:20180847)。

摘　　要：目的 探究重型颅脑损伤患者近期死亡的危险因素,分析动静脉氧压差[P(v-a)O_(2)]联合血清巨噬细胞移动抑制因子(MIF)水平对重型颅脑损伤患者近期死亡的预测价值。方法 选取河北北方学院附属第一医院2015年12月—2021年1月收治重型颅脑损伤住院患者89例为研究对象,并根据随访28 d分为生存组(48例)和死亡组(41例)。比较两组一般资料及生化指标。采用血气分析仪检测静脉及动脉血氧分压,并计算P(v-a)O_(2)。用酶联免疫吸附法(ELISA)测定血清MIF水平。多因素Logistic回归分析重型颅脑损伤患者近期死亡的影响因素,采用受试者工作特征曲线(ROC)分析P(v-a)O_(2)联合血清MIF水平预测近期死亡风险值。结果 生存组、死亡组受伤后至手术时间、GCS评分、颅内血肿位置差异有统计学意义(P<0.05);与生存组相比,死亡组P(v-a)O_(2)、血清MIF水平较高(P<0.05)。多因素Logistic回归分析表明,P(v-a)O_(2)、血清MIF是重型颅脑损伤患者近期死亡的危险因素(P<0.05),ROC曲线显示,P(v-a)O_(2)、血清MIF水平预测重型颅脑损伤患者近期死亡的曲线下面积(AUC)分别为0.850、0.790;两者联合预测重型颅脑损伤患者近期死亡的AUC为0.881,其敏感度、特异性分别为81.30%、90.20%。结论 P(v-a)O_(2)、血清MIF水平是重型颅脑损伤患者近期死亡的危险因素,P(v-a)O_(2)、血清MIF对重型颅脑损伤患者近期死亡具有一定的预测价值。Objective To investigate the predictive value of arterial-venous oxygen pressure difference [P(v-a)O_(2)]combined with serum macrophage migration inhibitory factor(MIF) level for short-term death in patients with severe head injury.Methods A total of 89 patients with severe head injury were divided into survival group(n=48) and death group(n=41) according to the 28-day follow-up.The general information and biochemical parameters of the two groups were compared.Blood gas analyzer was usedat admission to measure the partial pressures of oxygen in venous blood and arterial blood and P(v-a)O_(2)was calculated.Peripheral venous blood samples were collected during 24 h after treatment to test the serum MIF level by ELISA.Multiple Logistic regression analysis was used to analyze the influencing factors of recent death in the patients,and receiver operating characteristic curve(ROC) was used to analyze the value of P(V-A)O_(2)combined with serum MIF level in predicting the risk of recent death.Results The GCS score of the surviving group was(6.02±1.55),significantly higher than that of the death group [(4.46±1.46),P<0.05].The time [(7.04±2.01)h],significantly shorter than that of the death group [(8.52±2.06),P<0.05].The time between injury and operation of the survival group was [(7.04±2.01)h],significantly shorter thasn that of the death group[(8.52±2.06)h,P<0.05].The location of hematoma.The P(v-a)O_(2)level of the death group was(68.94±17.21)mmHg,significantly higher than that of the survival group [(32.37±7.12) mmHg,P<0.001].The serum MIF level of the death group was [(66.41±13.62) ng/mL],significantly higher than that of the survival group [(40.25±8.94) ng/mL,P<0.001].Compared with the survival group,the survival group had higher P(v-a)O_(2)and serum levels(P<0.05),and the survival group had higher level of MIF and serum level(P<0.05).Multivariate Logistic regression analysis showed that P(V-a)O_(2)and serum MIF were risk factors for short-term death in patients with severe head injury(P<0.05),P(V-A)O_(2)a

关 键 词：重型颅脑损伤 动静脉氧压差 巨噬细胞移动抑制因子 死亡风险 

分 类 号：R651.1[医药卫生—外科学]