摘要
目的探讨脑室外引流术(EVD)闭管试验中的颅内压(ICP)相关参数对急性闭合性颅脑损伤患者预后的预测价值。方法回顾性分析68例行EVD并脑室型ICP探头置入术治疗的急性闭合性颅脑外伤患者的临床资料。术后随访3个月,根据患者是否死亡、是否合并脑积水行分流手术、是否持续植物状态,将患者分为预后不良组(21例)与预后良好组(47例)。在EVD闭管试验期间每隔1 h记录1次ICP值,持续24 h,计算平均ICP变化率(ΔICP)及ICP累积负荷值。比较两组患者的ICP相关参数,并分别构建受试者工作特征曲线(ROC),评价其对预后的预测价值。结果闭管前,两组患者平均ICP的差异无统计学意义(P>0.05);闭管后,预后不良组患者的平均ICP明显高于预后良好组(P<0.05)。预后不良组患者的平均ICP变化率和ICP累积负荷值明显高于预后良好组(均P<0.05)。平均ICP变化率和ICP累积负荷值的ROC曲线下面积(AUC)分别为0.686(95%CI:0.554~0.819,P=0.0146)和0.727(95%CI:0.580~0.874,P=0.0029);两条ROC曲线的最佳截断值分别为0.195和25.185。结论对急性闭合性颅脑损伤并置入脑室型ICP探头的患者进行EVD拔管前闭管试验时的ICP相关参数(平均ICP变化率与ICP累积负荷值),对患者的预后具有一定的预测价值。
Objective To investigate the prognostic value of intracranial pressure(ICP)related parameters in weaning test of external ventricular drainage(EVD)in patients with acute closed craniocerebral injury.Methods The clinical data of 68 patients with acute closed traumatic brain injury(TBI)underwent EVD and ICP probe implantation were analyzed retrospectively.The patients were followed up for 3 months according to whether the patient died,post-trauma hydrocephalus and persistent vegetative state.The patients were divided into poor prognosis group(n=21)and good prognosis group(n=47).The age,gender,pupillary light reflex,Glasgow coma scale(GCS)after admission,Marshall CT scale,modified Fisher scale,intraventricular hemorrhage,type of operation,days of EVD catheterization and intensive care unit(ICU)admission days were recorded.ICP was recorded every 1 hour during the EVD weaning and lasted for 24 hours.The average change rate of ICP(ΔICP)and cumulative ICP burden were calculated and receiver operating characteristic curve(ROC)was constructed to evaluate its value in predicting the prognosis of TBI patients.Results There was no significant difference in mean ICP between the two groups before tube closure(P>0.05).After tube closure,the mean ICP in the poor prognosis group was significantly higher than that in the good prognosis group(P<0.05).The mean ICP change rate and ICP cumulative load in the poor prognosis group were significantly higher than those in the good prognosis group(all P<0.05).The area under ROC curve(AUC)of average ICP change rate and ICP cumulative load value were 0.686(95%CI:0.554-0.819,P=0.0146)and 0.727(95%CI:0.580-0.874,P=0.0029),respectively.The best cut-off values of the two ROC curves were 0.195 and 25.185 respectively.Conclusion The ICP related parameters(mean ICP change rate and ICP cumulative load value)in the weaning test before EVD extubation for patients with acute closed craniocerebral injury and ventricular ICP probe have a certain predictive value for the prognosis of patients.
作者
陈星兆
顾嘉程
龚如
章素芳
曹轲
毛青
CHEN Xing-zhao;GU Jia-cheng;GONG Ru(Brain Injury Center,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China)
出处
《临床神经外科杂志》
2022年第1期59-63,共5页
Journal of Clinical Neurosurgery
基金
国家自然科学基金(81571883)。
关键词
脑室外引流
颅内压监测
颅内压相关参数
颅脑损伤
external ventricular drainage
intracranial pressure monitoring
intracranial pressure related parameters
traumatic brain injury
