床旁经骨窗超声检查评估颅脑外伤去骨瓣减压术患者的预后  

Bedside Bone Window Ultrasound for Prognosis of Traumatic Brain Injury after Decompressive Craniectomy

作　　者：李俊[1] 程智慧 许东伟[1] 沈侃[1] 余画 王云峰 邓星奇 LI Jun;CHENG Zhihui;XU Dongwei;SHEN Kan;YU Hua;WANG Yunfeng;DENG Xingqi(Department of Critical Care Medicine,Shanghai University of Medicine&Health Sciences Affiliated Zhoupu Hospital,Shanghai 201318,China)

机构地区：[1]上海健康医学院附属周浦医院重症医学科,上海201318

出　　处：《医学综述》2024年第8期1020-1024,F0003,共6页Medical Recapitulate

基　　金：上海市浦东新区卫生健康委员会面上项目(PW2021A-78)。

摘　　要：目的探讨床旁经骨窗超声检查对颅脑外伤去骨瓣减压术(DC)患者预后的评估价值。方法纳入2021年7月至2023年7月在上海健康医学院附属周浦医院重症医学科接受DC治疗的42例颅脑外伤患者为研究对象。分别于术后第1、2、3、5、7天经骨窗测量中线移位(MLS)以及大脑中动脉的收缩期血流速度(FVs)和舒张期血流速度(FVd),计算平均血流速度(FVm)和脉动指数(PI)。随访患者30 d,根据格拉斯哥预后评分分为预后不良组(≤3分)和预后良好组(>3分),比较两组患者的临床资料。采用Logistic回归分析影响患者预后的因素,绘制受试者工作特征曲线(ROC曲线)分析超声参数对患者预后的评估价值。结果42例患者中,预后不良23例,预后良好19例。预后不良组入院时格拉斯哥昏迷评分低于预后良好组(P<0.01),严重颅脑外伤比例和死亡率高于预后良好组(P<0.01)。预后不良组患者MLS大于预后良好组[6(2,9)mm比2(1,8)mm](P<0.01),FVs、FVd和FVm低于预后良好组[115(66,135)cm/s比132(112,144)cm/s、30(6,48)cm/s比48(42,57)cm/s、60(24,79)cm/s比77(65,86)cm/s](P<0.01),PI高于预后良好组[1.6(1.2,2.3)比1.0(0.9,1.1)](P<0.01)。ROC曲线分析显示,PI预测不良预后的曲线下面积最大,为0.861(95%CI 0.803~0.907),灵敏度为67.78%,特异度为95.79%。多因素回归分析显示,PI升高是颅脑外伤DC患者术后30 d预后不良的独立危险因素(OR=1.076,95%CI 1.048~1.105,P<0.01)。12例患者在DC术后第1~12天内死亡,死亡前均出现FVd消失。结论床旁经骨窗超声检查可用于预测颅脑外伤DC患者的预后。PI升高是预后不良的独立危险因素,而FVd消失预示着死亡。Objective To explore the prognostic value of bedside bone window ultrasound in patients with traumatic brain injury after decompressive craniectomy(DC).Methods This study included 42 patients with traumatic brain injury who underwent DC at the Department of Critical Care Medicine,Shanghai University of Medicine&Health Sciences Affiliated Zhoupu Hospital from Jul.2021 to Jul.2023.The degree of midline shift(MLS),systolic flow velocity(FVs)and diastolic flow velocity(FVd)of the middle cerebral artery were measured through bone window on days 1,2,3,5 and 7 postoperatively,and the mean flow velocity(FVm)and pulsatility index(PI)were calculated.The patients were followed up for 30 days and divided into a poor prognosis group(≤3 points)and a good prognosis group(>3 points)according to Glasgow prognostic scale score.The clinical data of the two groups were compared.Logistic regression analysis was used and the receiver operating characteristic curve(ROC curve)was drawn to analyze the value of ultrasound parameters in evaluating the prognosis of such patients.Results Among the 42 patients,23 had poor prognosis and 19 had a good prognosis.The Glasgow coma score at admission of the poor prognosis group was lower than the good prognosis group(P<0.01),and the proportion of severe brain trauma and mortality rate were higher than those of the good prognosis group(P<0.01).The MLS in the poor prognosis group was greater than that in the good prognosis group[6(2,9)mm vs 2(1,8)mm](P<0.01),FVs,FVd and FVm were lower than those of the good prognosis group[115(66,135)cm/s vs 132(112,144)cm/s,30(6,48)cm/s vs 48(42,57)cm/s,60(24,79)cm/s vs 77(65,86)cm/s](P<0.01),PI was higher than that in the good prognosis group[1.6(1.2,2.3)vs 1.0(0.9,1.1)](P<0.01).The ROC curve analysis showed that PI for predicting poor prognosis had the largest area under the curve of 0.861(95%CI 0.803-0.907),with the sensitivity of 67.78%and the specificity of 95.79%.Multivariate regression analysis showed that elevated PI was an independent risk factor for poor

关 键 词：脑外伤 去骨瓣减压术 经颅超声 预后 

分 类 号：R651.11[医药卫生—外科学] R445[医药卫生—临床医学]