颅内压对外伤性脑损伤患者生存状况的影响
| 作者: |
1李文
1 南部县人民医院神经外科，四川 南充 637000 |
| 通讯: |
李文
Email: 1421334821@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2018.11.022 |
摘要
目的：探索颅内压(intracranial pressure，ICP)对外伤性脑损伤患者生存状况的影响。方法：回顾性分析2015年3月至2018年3月于南部县人民医院接受治疗的132例外伤性脑损伤患者的临床资料，根据患者出院后格拉斯哥预后分级(Glasgow outcome grading，GOS)评分结果分为预后良好组(n=74)和预后不良组(n=58)。收集患者ICP相关参数包括脑灌注压(cerebral perfusion pressure，CPP)、ICP均值、ICP波幅、压力反应指数(pressure response index，PRx)、ICP波幅与动脉压波幅相关系数(ICP-arterial blood pressure wave amplitude correlation，IAAC)、ICP相关系数(regression of amplitude and pressure，RAP)等临床资料，对有统计学意义的相关因素行多因素Logistic回归分析，采用GP 6.0软件计算ICP，PRx在不同阈值基线之上的曲线下面积。结果：预后不良组ICP，PRx，IAAC均显著高于预后良好组，CPP显著低于预后良好组，数据对比差异有统计学意义(P<0.05)；年龄、性别、入院时GOS评分、神经外科重症监护室(neurosurgical intensive care unit，NICU)入住时间、RAP对比差异无统计学意义(P>0.05)。对影响外伤性脑损伤患者生存状况的因素进行多因素logistic回归分析，结果显示ICP和PRx是影响外伤性脑损伤患者生存状况的独立危险因素(P<0.05)。受试者工作特征(receiver operating characteristic，ROC)曲线显示DICP20曲线下面积为0.69，DICP22曲线下面积为0.72。DPRx0.25曲线下面积为0.98，DPRx0.05曲线下面积为0.95。两组患者均进行大骨瓣减压，预后良好组术后发现再出血1例(1.35%)，预后不良组6例(10.34%)；预后良好组术后发现脑积水2例(2.70%)，预后不良组9例(15.52%)，差异有统计学意义(P<0.05)。结论：ICP和PRx是影响外伤性脑损伤患者生存状况的独立危险因素，对ICP和PRx不同阈值进行ROC曲线下面积计算可以作为判断外伤性脑损伤患者不良预后的参数，且PRx作为参数计算准确性更高。
关键词：
颅内压；外伤性脑损伤；生存状况
Effect of intracranial pressure on survival of patients with traumatic brain injury
CorrespondingAuthor: LI Wen Email: 1421334821@qq.com
DOI: 10.3978/j.issn.2095-6959.2018.11.022
Abstract
Objective: To explore the effect of intracranial pressure (ICP) on the survival of patients with traumatic brain injury. Methods: The clinical data of 132 patients with traumatic brain injury who were treated in our hospital from March 2015 to March 2018 were analyzed retrospectively. The results were divided into good prognosis group (n=74) and poor prognosis group (n=58) according to the results of Glasgow outcome grading (GOS). ICP related parameters including cerebral perfusion pressure (CPP), ICP mean, ICP amplitude, pressure response index (PRx), ICP amplitude and arterial pressure amplitude correlation coefficient (IAAC), ICP correlation coefficient (RAP) were collected, and multiple factor Logistic regression analysis for statistically significant factors was performed by GP 6.0 software. The area under the curve of ICP and PRx over different threshold baselines. Results: ICP, PRx and IAAC in poor prognosis group were significantly higher than those in good prognosis group, and CPP was significantly lower than good prognosis group, and the data comparison was statistically significant (P<0.05). There was no statistical difference between age, sex, GOS score at admission, NICU time and RAP contrast (P>0.05). Multiple factors Logistic regression analysis on the factors affecting the survival of patients with traumatic brain injury showed that ICP and PRx were independent risk factors affecting the survival of patients with traumatic brain injury (P<0.05). The receiver operating characteristic (ROC) curve showed that the area under the DICP20 curve was 0.69 and the area under the DICP22 curve was 0.72. The area under the DPRx0.25 curve is 0.98 and the area under the DPRx0.05 curve is 0.95. The patients in both groups underwent decompression of large bone flap. The prognosis was good in one group and the postoperative rebleeding was 1.35%. In the poor prognosis group, 6 cases were 10.34%. In the prognosis group, 2 cases of hydrocephalus were found to be 2.70%, the poor prognosis group found that 9 cases accounted for 15.52%, the data were statistically significant (P<0.05). Conclusion: ICP and PRx are independent risk factors for the survival of patients with traumatic brain injury. The calculation of area under the ROC curve for different threshold of ICP and PRx can be used as a parameter to judge the bad prognosis of traumatic brain injury, and the accuracy of PRx as a parameter is higher.
Keywords：
intracranial pressure; traumatic brain injury; survival condition