多模态监测在重型颅脑损伤患者预后评估中的临床应用价值  

Clinical Application Value of Multimodal Monitoring in Prognosis Evaluation of Patients with Severe Craniocerebral Injury

作　　者：黎会[1] 吴文昌[1] 吴雪松[1] LI Hui;WU Wenchang;WU Xuesong(Department of Neurosurgery,Yulin First People's Hospital,Yulin 537000,China)

机构地区：[1]广西玉林市第一人民医院神经外科,广西玉林537000

出　　处：《中国医药指南》2023年第4期1-5,共5页Guide of China Medicine

基　　金：2020年玉林市科学研究与技术开发计划项目[课题名称:多模态监测在评估重型颅脑损伤临床应用价值研究(编号:玉市科20204308)]。

摘　　要：目的 探究多模态监测在重型颅脑损伤患者预后评估中的临床应用价值。方法 选取2019年1月至2021年6月我科重症监护病房的重型颅脑损伤患者,其中接受多模态监测的81例患者为观察组,接受常规监测的78例患者为对照组;将入组病例亚分为手术组与非手术组,观察组手术患者59例、非手术患者22例,对照组手术患者61例、非手术患者17例。比较各组临床资料、ICU住院时间、神经系统并发症发生情况、发病后6个月预后情况;分析颅内压、大脑中动脉阻力指数(RI)对不良预后的预测价值。结果 观察组与对照组患者性别、年龄、BMI、受伤原因、受伤至入院时间、GCS评分以及入院时体温、平均动脉压、血钠、尿素氮、红细胞计数、血细胞比容比较,差异无统计学意义(P> 0.05)。观察组手术与非手术患者ICU住院时间短于对照组手术与非手术患者,差异有统计学意义(P <0.05);观察组手术患者神经系统并发症发生率低于对照组手术患者,差异有统计学意义(χ^(2)=7.139,P=0.008);观察组手术患者预后不良率低于对照组手术患者,差异有统计学意义(χ^(2)=8.366,P=0.004)。预后不良组患者颅内压、大脑中动脉RI高于预后良好组,差异有统计学意义(P<0.05)。ROC曲线显示:颅内压、大脑中动脉RI预测不良预后的AUC为0.928、0.729;颅内压预测敏感度94.8%、特异度74.3%;大脑中动脉RI预测敏感度67.2%、特异度71.3%。结论 对重型颅脑损伤患者实施多模态监测可减少ICU住院时间及神经系统并发症,促进预后改善;颅内压、大脑中动脉RI对预后不良具有预测价值。Objective To explored the clinical application value of multimodal monitoring in the prognosis evaluation of patients with severe craniocerebral injury. Methods Patients with severe craniocerebral injury in the intensive care unit of our department from January 2019 to June 2021 were selected, 81 patients who received multimodal monitoring were the observation group, and 78 patients who received routine monitoring were the control group;The enrolled patients were subdivided into a surgical group and a non-surgical group. The observation group had 59 surgical patients and 22 non-surgical patients, and the control group had 61 surgical patients and 17 non-surgical patients. The clinical data, ICU length of stay, occurrence of neurological complications, and prognosis 6 months after onset were compared among the groups;the predictive value of intracranial pressure and middle cerebral artery RI for poor prognosis was analyzed. Results There was no statistical difference between the observation group and the control group in terms of gender, age, BMI, cause of injury, time from injury to admission, GCS score, body temperature at admission, mean arterial pressure, blood sodium, blood urea nitrogen, red blood cell count, and hematocrit academic significance(P>0.05). The ICU hospitalization time in the observation group of patients with surgery and non-surgery was shorter than that of patients with surgery and nonsurgery in the control group, and the difference was statistically significant(P<0.05). The incidence of neurological complications in the observation group was lower than that in the control group, the difference was statistically significant(χ^(2)=7.139, P=0.008). The poor prognosis rate of the patients in the observation group was lower than that of the patients in the control group, and the difference was statistically significant(χ^(2)=8.366, P=0.004).The intracranial pressure and middle cerebral artery RI in the poor prognosis group were higher than those in the good prognosis group, and the difference w

关 键 词：重型颅脑损伤 多模态监测 预后 

分 类 号：R651.1[医药卫生—外科学]