床旁经颅多普勒超声参数搏动指数与神经危重症患者颅内压及预后的关系  

Relationship between the bedside transcranial Doppler ultrasound pulse index and intracranial pressure and prognosis in patients with neurocritical disease

作　　者：李梦迪 娄君鸽 张小艳 闫媛媛 LI Mengdi;LOU Junge;ZHANG Xiaoyan;YAN Yuanyuan(Department of Ultrasound Medicine,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学附属郑州中心医院超声医学科,河南郑州450000

出　　处：《医学影像学杂志》2025年第2期11-14,23,共5页Journal of Medical Imaging

基　　金：河南省科技攻关项目(编号:182102310458);河南省高等学校重点科研项目(编号:19A320077)。

摘　　要：目的分析床旁经颅多普勒超声(TCD)参数搏动指数(PI)与神经危重症患者颅内压(ICP)及预后的关系。方法选取本院收治的184例神经危重症患者为观察对象,均行TCD检查,获得PI水平,并行腰椎穿刺术测量ICP水平,采用Pearson相关性分析法分析PI值与ICP值的相关性。根据患者住院期间是否发生死亡分为死亡组33例和存活组151例。比较死亡组和存活组临床资料、PI、ICP,采用多因素分析影响神经危重患者发生死亡的危险因素,并绘制受试者工作特征(ROC)曲线分析PI对神经危重患者发生死亡的预测价值。结果患者PI、ICP水平分别为1.37±0.26、(20.77±3.18)mmHg,Person相关性分析显示神经危重患者PI水平与ICP呈正相关(r=0.549,P<0.05)。死亡组ICU住院时间、PI、ICP水平高于存活组,差异有统计学意义(P<0.05),格拉斯哥昏迷评分(GCS)水平低于存活组,差异有统计学意义(P<0.05)。Logistic回归分析结果显示ICU住院时间、PI、ICP、GCS水平异常均是影响神经危重症患者发生死亡的危险因素,差异均有统计学意义(P<0.05)。ROC曲线结果显示,PI预测神经危重患者发生死亡的AUC、敏感度、特异度分别为0.833(95%CI:0.741~0.925)、87.90%、78.10%。结论TCD参数PI与神经危重症患者ICP呈正相关,且是影响神经危重症患者发生死亡的危险因素,PI对神经危重症患者发生死亡具有较高的预测价值。Objective To analyze the relationship between the bedside transcranial doppler ultrasound(TCD)pulse index(PI)and intracranial pressure(ICP)and prognosis of patients with neurocritical disease.Methods A total of 184 patients with severe neurological diseases admitted were selected as the study objects.TCD examination was performed to obtain PI levels.ICP levels were measured by bedside lumbar puncture.Pearson correlation analysis was used to analyze the correlation between PI values and ICP values.Patients were divided into death group and survival group according to whether death occurred during hospitalization.The clinical data,PI and ICP of the death group and the survival group were compared,and the risk factors affecting the death of patients with neurocritical conditions were analyzed by multi-factor analysis,and the predictive value of PI in the death of patients with neurocritical conditions was analyzed by drawing receiver operating characteristic(ROC)curve.Results PI and ICP levels of patients were(1.37±0.26)and(20.77±3.18)mmHg,respectively.Person correlation analysis showed that PI level of patients with critical neurological conditions was positively correlated with ICP(r=0.549,P<0.05).The level of ICU stay,PI and ICP in death group was higher than that in survival group(P<0.05),and the level of Glasgow Coma Score(GCS)was lower than that in survival group(P<0.05).Logistic regression analysis showed that the length of hospital stay in ICU,abnormal levels of PI,ICP and GCS were risk factors for death in neurocritical ill patients(P<0.05).ROC curve results showed that the AUC,sensitivity,specificity,and optimal cut-off values of PI in predicting death in critically ill patients were 0.833(95%CI:0.741-0.925),87.90%,and 78.10%,respectively.Conclusion TCD-PI is positively correlated with ICP in patients with neurocritical ill,and is a risk factor for death in patients with this disorder.PI has a high predictive value for death in patients with neurocritical ill.

关 键 词：床旁经颅多普勒超声 搏动指数 神经危重症患者 颅内压 预后 

分 类 号：R651[医药卫生—外科学] R445.1[医药卫生—临床医学]