颈内动脉和大脑中动脉超声搏动指数对重型创伤性脑损伤患者颅内压的预测价值  

Value of pulsatility index of internal carotid artery and middle cerebral artery in predicting intracranial pressure of patients with severe traumatic brain injury

作　　者：朱晓明[1] 张莉[1] 杨杨[1] 杨阳[1] 张亮[1] 马莉[1] 杨理坤[1] 王玉海[1] Zhu Xiaoming;Zhang Li;Yang Yang;Yang Yang;Zhang Liang;Ma Li;Yang Likun;Wang Yuhai(Department of Neurosurgery,904th Hospital of Joint Logistic Support Force of PLA(Wuxi Taihu Hospital),Wuxi 214004,China)

机构地区：[1]中国人民解放军联勤保障部队第九O四医院(无锡太湖医院)神经外科,无锡214004

出　　处：《中华创伤杂志》2024年第4期330-335,共6页Chinese Journal of Trauma

基　　金：无锡市现代产业发展资金(Y20222025)。

摘　　要：目的:评估颈内动脉(ICA)和大脑中动脉(MCA)超声搏动指数(PI)对重型创伤性脑损伤(sTBI)患者颅内压的预测价值。方法:采用回顾性病例系列研究分析2021年1月至2023年8月中国人民解放军联勤保障部队第九〇四医院收治的104例sTBI患者的临床资料,其中男73例,女31例;年龄16~77岁[(56.4±15.9)岁]。格拉斯哥昏迷评分(GCS)3~8分[(6.1±1.6)分]。收集sTBI患者有创颅内压监测术后176例次ICA和MCA的经颅多普勒(TCD)超声平均血流速度(Vm)和PI,以及收缩压(SBP)、舒张压(DBP)及心率(HR)等血流动力学参数。根据176例次有创颅内压监测值分为颅内压正常组(≤20 mmHg,126例次)和颅内压增高组(>20 mmHg,50例次)。比较两组ICA和MCA的Vm、PI和血流动力学参数的差异。Pearson相关分析评估ICA和MCA的PI与有创颅内压之间相关性并作直线回归分析。Bland-Altman差异分析评估ICA和MCA的PI预测颅内压与有创颅内压的一致性。绘制受试者工作特征曲线(ROC)分析ICA和MCA的PI预测颅内压增高的能力,并计算曲线下面积(AUC)、95% CI、灵敏度和特异度。 结果:颅内压增高组中ICA和MCA的PI分别为1.21±0.24、1.22±0.25,显著高于颅内压正常组的1.12±0.15、1.13±0.20( P<0.05或0.01),两组ICA和MCA的Vm及SBP、DBP、HR差异均无统计学意义( P>0.05)。Pearson相关分析结果表明,ICA和MCA的PI与有创颅内压显著相关( r=0.29, P<0.01;r=0.31, P<0.01)。Bland-Altman结果显示,ICA的PI预测颅内压的平均偏差为+0.08 mmHg,MCA的PI预测颅内压的平均偏差为+0.16 mmHg( P>0.05)。ROC曲线结果表明,ICA和MCA的PI诊断颅内压增高的AUC分别为0.61(95% CI 0.52,0.70)和0.60(95% CI 0.51,0.70),灵敏度为58%和50%,特异性为60%和74%。两者的AUC差异无统计学意义( P>0.05)。 结论:ICA和MCA的TCD超声PI在辅助动态预测sTBI患者的颅内压和诊断颅内高压上无明显差异,但预测的准确性和稳定性有待提高。Objective To assess the predictive value of pulsatility index(PI)of internal carotid artery(ICA)and middle cerebral artery(MCA)in intracranial pressure assessment of patients with severe traumatic brain injury(sTBI).Methods A retrospective case series study was conducted to analyze the clinical data of 104 sTBI patients who were admitted to 904th Hospital of Joint Logistic Support Force of PLA from January 2021 to August 2023,including 73 males and 31 females,aged 16-77 years[(56.4±15.9)years].The Glasgow Coma Scale(GCS)scores were 3-8 points[(6.1±1.6)points].A total of 176 detections of mean blood flow velocity(Vm)and PI of ICA and MCA by transcranial Doppler(TCD)ultrasonography after invasive intracranial pressure monitoring as well as hemodynamic parameters such as systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)were collected.The patients were divided into normal intracranial pressure group(intracranial pressure≤20 mmHg,126 detections)and intracranial hypertension group(intracranial pressure>20 mmHg,50 detections)according to the 176 detections obtained by invasive intracranial pressure monitoring.The Vm and PI of ICA and MCA and the hemodynamic parameters were compared between the two groups.Pearson correlation analysis was used to assess the correlation between PI of ICA and MCA and invasive intracranial pressure and linear regression analysis was conducted.The Bland-Altman difference analysis was applied to assess the consistency between intracranial pressure predicted by PI of ICA and MCA and invasive intracranial pressure.The receiver operating characteristic(ROC)curve was plotted to analyze the capacity of PI of ICA and MCA in predicting intracranial hypertension and the area under the curve(AUC),95%CI,sensitivity and specificity were calculated.Results In the intracranial hypertension group,the PI values of ICA and MCA were 1.21+0.24 and 1.22±O.25 respectively,which were significantly higher than those in the normal intracranial pressure group(1.12±0.15 and 1.13±0.20

关 键 词：脑损伤 经颅多普勒超声检查 颅内压增加 搏动指数 

分 类 号：R651.15[医药卫生—外科学]