局部脑氧饱和度监测在PICU昏迷患儿预后评估中的价值  

The value of monitoring regional cerebral oxygen saturation in the prognosis assessment of comatose children in PICU

作　　者：高刘炯 李小磊 梅世月 金志鹏[1] 苏军[1] Gao Liujiong;Li Xiaolei;Mei Shiyue;Jin Zhipeng;Su Jun(Children's Hospital Affiliated to Zhengzhou University,Henan Children's Hospital,Zhengzhou Children's Hospital,Zhengzhou 450000,China;Children's Hospital Affiliated to Zhengzhou University,Key Laboratory of Childhood Genetic Metabolic Diseases of Henan Province,Zhengzhou 450000,China)

机构地区：[1]郑州大学附属儿童医院、河南省儿童医院郑州儿童医院PICU,450000 [2]郑州大学附属儿童医院、河南省儿童遗传代谢性疾病重点实验室,450000

出　　处：《中国小儿急救医学》2023年第4期276-280,共5页Chinese Pediatric Emergency Medicine

基　　金：河南省2019年科技发展计划项目(192102310340)。

摘　　要：目的探讨局部脑氧饱和度(rSO_(2))监测在PICU中昏迷患儿预后评估中的价值。方法收集2019年1月至2021年9月入住河南省儿童医院PICU的昏迷患儿127例,根据格拉斯哥昏迷评分(GCS)将患儿分为轻度(13~15分)、中度(9~12分)、重度(3~8分)昏迷组。采用脑氧监测仪监测所有患儿治疗前及治疗第3、7、14天的rSO_(2);根据儿童出院前的脑功能分类评分(PCPC)评估患儿结局,分为痊愈组(1分)、残疾组(2~4分)和预后不良组(5~6分),采用多元线性回归及受试者工作特征曲线分析rSO_(2)与PCPC评分之间的相关性。结果轻度、中度、重度昏迷组治疗前的rSO_(2)分别为(78.06±3.21)%、(66.07±6.05)%、(52.87±6.49)%,差异有统计学意义(F=209.263,P<0.05)。治疗前的rSO_(2)与GCS评分呈正相关(r=0.806,P<0.05)。痊愈组、残疾组、预后不良组患儿治疗前及治疗第3、7、14天组间rSO_(2)比较差异均有统计学意义(P<0.05),其中痊愈组高于残疾组,残疾组高于预后不良组,且随着时间进展,3组患儿的rSO_(2)均呈升高趋势(P<0.05)。多元线性回归分析结果显示,治疗第7、14天的rSO_(2)是患儿预后的独立影响因素(OR-0.042,95%CI-0.082~0.003,P<0.05;OR-0.047,95%CI-0.094~0.000,P<0.05);受试者工作特征曲线分析结果显示,治疗第7天的rSO_(2)对昏迷患儿的预后预测价值相对较高,预测患儿预后脑功能异常和预后无清醒的曲线下面积分别为0.741和0.746。结论监测rSO_(2)对PICU昏迷患儿的脑功能预后具有预测价值,其中治疗第7天rSO_(2)的预后预测价值较高,可作为PICU昏迷患儿预后评估的参考指标。Objective To evaluate the value of monitoring regional cerebral oxygen saturation(rSO_(2))in the prognosis of comatose children in pediatric intensive care unit(PICU).Methods A total of 127 coma children who admitted to PICU at Henan Children′s Hospital from January 2019 to September 2021 were collected and divided into mild[Glasgow coma score(GCS):13-15],moderate(GCS:9-12)and severe coma(GCS:3-8)groups according to GCS.A cerebral oxygen monitor was used to monitor the rSO_(2)of all children before treatment,and on the 3rd,7th and 14th day after treatment.The outcomes were assessed according to the pediatric cerebral performance category(PCPC),and the children were divided into recovery group(PCPC score:1),disability group(PCPC score:2-4)and poor prognosis group(PCPC score:5-6).Multiple linear regression and receiver operating characteristic(ROC)curve were used to analyze the correlation between rSO_(2)and PCPC score.Results rSO_(2)in mild,moderate and severe coma groups before treatment were(78.06±3.21)%,(66.07±6.05)%,and(52.87±6.49)%,respectively(F=209.263,P<0.05).rSO_(2)before treatment was positively correlated with GCS(r=0.806,P<0.05).There were significant differences in rSO_(2)among recovery group,disability group and poor prognosis group before treatment and that on the 3rd,7th and 14th day after treatment(P<0.05).Notably,rSO_(2)in recovery group was higher than that in disability group,and rSO_(2)in disability group was higher than that in poor prognosis group.The rSO_(2)of three groups showed an increasing trend over time(P<0.05).Multiple linear regression analysis showed that rSO_(2)on the 7th and 14th day of treatment were independent prognostic factors(OR-0.042,95%CI-0.082~0.003,P<0.05;OR-0.047,95%CI-0.094~0.000,P<0.05).ROC analysis showed that rSO_(2)on the 7th day of treatment had a relatively higher prognostic value for children in coma,and the area under the ROC curve for predicting the prognosis of abnormal brain function and no wakefulness were 0.741 and 0.746,respectively.Conclusion Monit

关 键 词：脑氧饱和度 昏迷 儿童重症监护室 预后 

分 类 号：R720.597[医药卫生—急诊医学]