摘要
目的探讨老年重度颅脑损伤患者的营养风险与其神经功能预后的关系。方法纳入2019年5月至2021年10月南通大学附属海安医院神经外科收治的127例老年重度颅脑损伤患者为研究对象。使用预后营养指数(prognostic nutri⁃tional index,PNI)和危重症营养风险(nutrition risk in critically ill,NUTRIC)评分对患者的营养风险进行评估。多因素Logistic回归分析法分析患者发病6个月时神经功能(改良Rankin量表,mRS)预后的危险因素并构建风险模型。结果与PNI≥45分组患者比较,PNI<45分组格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分较低,肺部感染比例、mRS≥3分比例较高(均P<0.05)。与NUTRIC<5分组比较,NUTRIC≥5分组患者的GCS评分较低且mRS≥3分比例较高(均P<0.05)。与mRS<3分组比较,mRS≥3分组患者年龄较大,开放性伤比例、闭合伤比例、肺部感染比例、合并蛛网膜下腔出血比例、NUTRIC评分较高,GCS评分、PNI评分较低(均P<0.05)。年龄、肺部感染、GCS评分和PNI评分是影响患者神经功能预后的危险因素(均P<0.05)。基于PNI评分的风险模型鉴别老年重度颅脑损伤患者神经功能预后不良的曲线下面积(area under the curve,AUC)为0.92,敏感性和特异性分别为79.5%和90.7%;基于NUTRIC评分的模型对应的AUC为0.89,敏感性和特异性分别为89.0%和79.6%。结论基于PNI评分和NUTRIC评分的营养状态评估与重度颅脑损伤患者发病6个月时的神经功能预后密切相关。营养状态差的老年患者其短期神经功能预后较差。
Objective To investigate the relationship between nutritional risk indexes and neurological prognosis in elderly patients with severe craniocerebral injury.Methods A total of 127 elderly patients with severe craniocerebral injury admitted to our hospital from May 2019 to October 2021 were enrolled in this retrospective study.The nutritional risk of the patients was assessed by the prognostic nutritional index(PNI)and nutrition risk in critically ill(NUTRIC)score.Multivariate logistic analysis was used to identify the risk factors affecting the prognosis of neurological function(modified Rankin scale,mRS)at 6 months of onset and a risk model was constructed.Results The patients with PNI<45 had lower Glasgow coma score(GCS)and higher proportions of pulmonary infection and mRS≥3 than the patients with PNI≥45(all P<0.05).The patients with NUTRIC≥5 had lower GCS and higher proportion of mRS≥3 than the patients with NUTRIC<5(all P<0.05).The patients with mRS≥3 were older and had higher proportions of open injury,closed injury,pulmonary infection and subarachnoid hemorrhage,higher NUTRIC score and lower GCS and PNI than the patients with mRS<3(all P<0.05).Age,pulmonary infection,GCS and PNI were risk factors affecting the prognosis of neurological function.The area under the curve(AUC)of the risk model based on the PNI for identifying poor neurological prognosis in elderly patients with severe brain injury was 0.92,with a sensitivity and specificity of 79.5%and 90.7%,respectively.The AUC of the model based on the NUTRIC score was 0.89,with a sensitivity and specificity of 89.0%and 79.6%,respectively.Conclusion Nutritional status assossment based on PNI and NUTRIC score is closely related to the neurological prognosis in patients with severe craniocerebral injury at 6 months after onset.The short⁃term neurological prognosis is poor in elderly patients with poor nutritional status.
作者
梅杰
管义祥
崔益秋
Mei Jie;Guan Yixiang;Cui Yiqiu(Department of Neurosurgery,Nantong University Affiliated Haian Hospital,Haian 226600,China)
出处
《海军医学杂志》
2024年第3期301-305,共5页
Journal of Navy Medicine
关键词
营养
老年
颅脑损伤
神经功能
预后
Nutrition
Elderly
Brain injury
Neurological function
Prognosis
