肺栓塞患者血清N末端脑钠肽前体、D-二聚体、内皮素1水平变化及临床意义

目的探讨肺栓塞患者血清N末端脑钠肽前体(NT-Pro BNP)、D-二聚体、内皮素1(ET-1)水平变化及其与病情、预后的关系。方法四川省凉山彝族自治州第二人民医院收治的95例急性肺血栓栓塞患者及50例健康成年人,分别纳入肺栓塞组及对照组。肺栓塞组患者进行危险度分层,分为高危组(18例)、中危组(43例)及低危组(34例),测定受试者血清NT-Pro BNP、D-二聚体、ET-1水平。结果①与对照组比较,肺栓塞组血清NT-Pro BNP、D-二聚体、ET-1水平升高(P0.05);高危组血清NT-Pro BNP、D-二聚体、ET-1水平高于中危组、低危组,中危组患者各指标水平高于低危组(P 0.05)。②入组患者好转出院85例,死亡10例,死亡组血清NT-Pro BNP、D-二聚体、ET-1水平高于存活组(P0.05)。③治疗后,肺栓塞患者血清NT-Pro BNP、D-二聚体、ET-1水平均降低(P0.05)。④血清NT-Pro BNP、D-二聚体、ET-1水平预测患者死亡的曲线下面积为0.832、0.810、0.751,血清NT-Pro BNP预测效能最高,当其截点值为1145.07 pg/ml时,约登指数最大,此时诊断敏感度及特异度分别为100%、60.00%。⑤NT-ProBNP联合D-二聚体、NT-ProBNP联合ET-1、D-二聚体联合ET-1及三者联合预测肺血栓患者预后的曲线下面积分别为0.907、0.882、0.845、0.916,其中三者联合预测价值最高。结论肺血栓栓塞患者伴有血清NT-Pro BNP、D-二聚体、ET-1水平的升高,且其水平与患者病情严重程度及预后相关,临床可将单独或联合用于预测患者预后。     

心肌型脂肪酸结合蛋白联合血浆D-二聚体对肺栓塞预后评估的临床意义

目的探讨心肌型脂肪酸结合蛋白(H-FABP)联合血浆D-二聚体在评价急性肺栓塞(APE)患者预后中的临床价值。方法选取本院2011年1月至2014年12月确诊的APE患者120例为研究对象,采用酶联免疫吸附法分别测定外周血H-FABP及D-二聚体浓度。根据病情严重程度将APE患者分为低危组、中危组及高危组;根据临床转归,分为存活组和死亡组,比较不同组间H-FABP和D-二聚体差异,评价H-FABP和D-二聚体对评估APE患者预后的临床价值。结果随着APE患者病情严重程度的增加,H-FABP和D-二聚体指标水平显著升高(P<0.05);死亡组H-FABP和D-二聚体水平显著高于存活组(P<0.05)。相关性分析显示,血浆H-FABP与D-二聚体水平呈正相关(r=0.693,P=0.000)。ROC曲线分析显示,H-FABP曲线下面积为0.845(95%CI:0.752~0.918),其最佳工作点为8.65μg/L,此时诊断APE的敏感性为81.24%,特异性为84.14%;D-二聚体曲线下面积为0.832(95%CI:0.728~0.899),其最佳工作点为1.25 mg/L,此时诊断APE的敏感性为83.72%,特异性为82.65%。结论 H-FABP联合D-二聚体可有效的评估APE患者病情严重程度及预后,可为临床APE患者个体化治疗,降低其死亡率提供客观依据。     

降钙素原、D-二聚体结合快速序贯器官功能衰竭评估评分在脓毒症诊疗中的应用

目的探讨降钙素原(PCT)、D-二聚体结合快速序贯器官功能衰竭评估(qSOFA)评分在脓毒症诊疗中的应用价值。方法回顾性研究确诊为脓毒症的患者96例,分析PCT、D-二聚体水平、qSOFA评分与病情的相关性。结果受试者工作特征(ROC)曲线分析,PCT的曲线下面积(AUC)为0.598(95%CI:0.562～0.602),灵敏度62.41%,特异度78.33%;D-二聚体的AUC为0.486(95%CI:0.462～0.503),灵敏度60.48%,特异度63.25%;qSOFA评分的AUC为0.601(95%CI:0.571～0.632),灵敏度64.35%,特异度70.25%;三者联合检测的AUC为0.821(95%CI:0.782～0.865),灵敏度88.23%,特异度83.54%。qSOFA评分2分组生存率高于qSOFA评分≥2分组。结论 PCT和D-二聚体可用于脓毒症严重程度的比较,PCT优于D-二聚体,结合qSOFA评分可以提高诊断的特异度和灵敏度,用于判断脓毒症患者的预后。     

PCT和D-二聚体在急诊脓毒症患者病情及预后预测中的应用评价

目的探讨在急诊脓毒症患者28d病死预测中,降钙素原(PCT)和D-二聚体的预测价值。方法运用回顾分析研究法,选取2015年1月至2016年12月该院急诊科接诊的脓毒症患者164例,分为脓毒症组(n=82)、重脓毒症组(n=55)、感染休克组(n=27),选择60例同期体检健康者为对照组,治疗前检测各组的PCT、D-二聚体水平。根据进入研究28d后生存情况分为存活组和死亡组,检测各组PCT、D-二聚体水平变化,分析独立预测因子,并以生存曲线评价预测价值。结果 164例脓毒症患者PCT、D-二聚体水平均高于对照组(P0.05);感染性休克组PCT、D-二聚体水平高于严重脓毒症组、脓毒症组,严重脓毒症组PCT、D-二聚体高于脓毒症组(P0.05)。对患者28d预后情况了解显示,164例脓毒症患者共61例死亡,死亡组患者PCT、D-二聚体水平高于存活组(P0.05);回归分析显示预后与PCT、D-二聚体水平呈正相关性(P0.05);应用Kaplan-Meier法分析PCT、D-二聚体不同情况对脓毒症预后的影响,生存组与死亡组生存曲线比较差异有统计学意义(P1=0.007 5,P2=0.001 7)。结论在脓毒症28d预后预测中,PCT、D-二聚体均属于独立危险因素,具有预测价值。     

中重度颅脑损伤患者28 d死亡影响因素分析及NLR联合GCS评分对其28 d死亡预测价值

目的探讨中重度颅脑损伤(traumatic brain injury,TBI)患者28 d死亡影响因素及中性粒细胞与淋巴细胞比值(neutrolphil to lymphocyte ratio,NLR)联合格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分对其28 d死亡预测价值。方法回顾性分析中重度TBI 628例的临床资料,根据28 d生存情况,将其分为病死组112例和存活组516例。采用单因素和多因素Logistic回归分析对中重度TBI患者28 d死亡影响因素进行分析,应用受试者工作特征(ROC)曲线分析NLR、GCS评分和NLR联合GCS评分对中重度TBI患者28 d死亡的预测价值。结果单因素分析结果显示,病死组入院时NLR、活化部分凝血酶原时间和C反应蛋白高于存活组,血红蛋白低于存活组;急诊手术治疗、坠落伤、瞳孔对光反应双阴、中线移位>5 mm、环池受压所占比例以及急性生理学及慢性健康状况评分系统Ⅱ评分高于存活组,GCS评分低于存活组,差异有统计学意义(P<0.05或P<0.01)。多因素Logistic回归分析结果显示,NLR>10.36、中线移位>5 mm和环池受压是中重度TBI患者28 d死亡的危险因素,GCS评分9~12分是中重度TBI患者28 d死亡的保护因素(P<0.01)。ROC曲线分析结果显示,NLR联合GCS评分预测中重度TBI 28 d死亡的曲线下面积(AUC)为0.892高于NLR、GCS评分单独预测中重度TBI 28 d死亡的AUC 0.745和0.827,且敏感度和特异度均较高。结论NLR>10.36、中线移位>5 mm和环池受压是中重度TBI患者28 d死亡的危险因素,GCS评分9~12分是中重度TBI患者28 d死亡的保护因素。NLR联合GCS评分对中重度TBI患者28 d死亡具有较高预测价值。     

D-二聚体、血小板计数、凝血酶原时间对重症肺炎患者预后的评估价值

目的:探究D-二聚体、血小板计数(platelet count,PLT)、凝血酶原时间(prothrombin time,PT)对重症肺炎患者预后的评估价值。方法:选取2020年11月至2021年10月东方市人民医院收治的9 0例重症肺炎患者为研究对象,收集所有患者一般资料及诊断2 4h内的D-二聚体、 P LT、 P T,根据28d预后将其分为死亡组与存活组。相关指标与重症肺炎患者预后的关系采用单因素及logistic回归分析,D-二聚体、PLT、PT对重症肺炎患者预后的评估价值采用受试者工作特征曲线(receiveroperatingcharacteristic,ROC)分析。结果:90例重症患者中28d死亡38例(42.22%)、存活52例(57.78%)。与存活组相比,死亡组急性生理与慢性健康状况评分系统II(Acute Physiology andChronicHealthEvaluationII,APACHEII)评分、P T及血清D-二聚体水平均明显更高,PLT水平则明显更低(均P<0.05)。Logistic回归分析显示:D-二聚体(OR=1.613)、PLT(OR=0.585)、P T(OR=1.317)均是重症肺炎患者死亡的独立影响因素(均P<0.05)。RO C曲线分析显示:D-二聚体、PLT、PT预测重症肺炎患者预后的曲线下面积(area under curve,AUC)分别为0.807、0.723、0.644,三者联合的AUC为0.958,敏感度为92.11%、特异度为84.62%。结论:D-二聚体、PLT、PT与重症肺炎患者预后密切相关,诊断24h内D-二聚体和PT较高、PLT较低提示患者死亡风险较大,三者联合应用对评估重症肺炎患者预后有重要价值。     

血乳酸联合神经元特异性烯醇化酶预测创伤性脑损伤患者预后的价值

目的:探讨血乳酸联合神经元特异性烯醇化酶(NSE)水平预测创伤性脑损伤(TBI)患者预后的价值。方法:选取我院收治的TBI患者148例,根据28 d预后情况分成存活组(n=117)和死亡组(n=31)。根据格拉斯哥昏迷评分(GCS)分为轻度组(n=96,9分≤GCS≤15分)和重度组(n=52,3分≤GCS≤8分)。比较各组第1、3、5天血乳酸及NSE水平变化。应用受试者工作特征(ROC)曲线分析血乳酸及NSE水平预测TBI患者死亡的价值。采用Pearson相关分析TBI患者血乳酸及NSE水平与GCS评分的相关性。结果:死亡组第1、3、5天血乳酸及NSE水平均明显高于存活组(P0.05),且死亡组血乳酸及NSE水平呈升高趋势(P0.05)。重度组第1、3、5天血乳酸及NSE水平均明显高于轻度组(P0.05),且重度组血乳酸及NSE水平呈升高趋势(P0.05)。ROC曲线显示,第3天血乳酸及NSE水平两项联合预测TBI患者死亡的曲线下面积最大(0.922,95%CI:0.858～0.970),其敏感度和特异度分别为92.6%和87.0%。相关分析显示,死亡组血乳酸及NSE水平与GCS评分均呈负相关(r=-0.763、-0.820,P0.01),血乳酸与NSE水平呈正相关(r=0.804,P0.01)。结论:血乳酸与NSE水平升高与TBI患者的病情严重程度相关,血乳酸联合NSE水平预测TBI患者预后的价值较高。     

血D-二聚体水平对腹膜透析相关性腹膜炎治疗失败的预测价值探讨CSCD

目的探讨治疗前D-二聚体对腹膜透析相关性腹膜炎(peritoneal dialysis-associated peritonitis,PDAP)治疗失败的预测价值。方法按照治疗效果把161例确诊为PDAP患者分为治疗成功组及治疗失败组,对2组患者的临床资料进行统计学比较,使用Logistic回归分析PDAP治疗失败的危险因素,运用受试者工作曲线(ROC)分析各危险因素对治疗失败的预测价值。结果治疗成功组的血清白蛋白(t=3.359,P=0.002)及首次腹膜炎发生率(χ^(2)=6.155,P=0.013)明显高于治疗失败组,其透析龄(Z=-3.314,P=0.001)、第3天透出液白细胞计数(Z=-3.951,P<0.001)、hs-CRP(Z=-3.093,P=0.002)、PCT(Z=-2.344,P=0.019)、纤维蛋白原(Z=-2.197,P=0.024)、D-二聚体(Z=-4.152,P<0.001)低于治疗失败组。单因素Logistic分析显示长透析龄(OR=1.025,95%CI:1.011~1.039,P<0.001)、高hs-CRP(OR=1.007,95%CI:1.002~1.012,P=0.008)、高PCT(OR=1.018,95%CI:1.002~1.034,P=0.029)、高纤维蛋白原(OR=1.568,95%CI:1.052~2.336,P=0.027)、高D-二聚体(OR=1.523,95%CI:1.165~1.991,P=0.002)、低血清白蛋白(OR=0.0915,95%CI:0.840~0.997,P=0.043)是PDAP治疗失败的危险因素;多因素Logistic分析显示长透析龄(OR=1.024,95%CI:1.008~1.039,P=0.003)、高D-二聚体(OR=1.419,95%CI:1.064~1.893,P=0.017)是PDAP治疗失败的独立危险因素。对比ROC曲线,D-二聚体的曲线下面积最大,为0.801,灵敏度和特异度分别为72.2%和76.2%。结论PDAP患者长透析龄、治疗前高水平D-二聚体与治疗失败独立相关,D-二聚体是预测PDAP治疗失败的良好指标。     

Balthazar CT评分联合血浆D-二聚体对重症急性胰腺炎患者预后的预测价值

目的探讨Balthazar CT评分联合血浆D-二聚体对重症急性胰腺炎(SAP)患者预后的预测价值。方法对2016年4月至2018年4月60例确诊为SAP的患者进行回顾性分析,根据SAP患者的预后分为存活组和死亡组,分析测定SAP患者住院不同时间段存活组和死亡组的Balthazar CT评分及其血浆D-二聚体水平。通过受试者工作特征(ROC)曲线分析Balthazar CT评分和血浆D-二聚体及二者联合对SAP预后的预测价值,计算曲线下面积(AUC)。结果与死亡组相比,存活组的Balthazar CT评分等级和血浆D-二聚体水平低(P0.05);在入院即刻,入院3d和入院7d时,Balthazar CT评分和血浆D-二聚体及两者联合共同预测SAP的AUC分别为0.67、0.85、0.97,0.81、0.92、0.98和0.83、0.97、0.99。结论 Balthazar CT评分联合血浆D-二聚体在一定程度上能够预测SAP的预后。     

D-二聚体对急性心肌梗死早期预后的预测价值——3134例急诊心肌梗死患者的回顾分析

目的 探讨D-二聚体能否作为急性心肌梗死(心梗)危险程度的预警信号,以帮助急诊医生对心梗患者进行风险评估.方法 回顾性分析2009年1月1日至2010年12月31日急诊入院的3134例患者病历资料,记录其年龄、性别、既往史,未接受治疗前的D-二聚体、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白Ⅰ(cTnⅠ)、N末端脑钠肽前体(NT-proBNP)、心电图变化,以及接受经皮冠状动脉介入治疗(PCI)或药物溶栓治疗2h后的CK-MB、cTnⅠ、心脏彩超左室射血分数(LVEF)值和住院期间是否死亡及发病至死亡时间;根据多因素logistic回归分析结果绘制受试者工作特征曲线(ROC曲线)和拟合曲线,分析治疗前D-二聚体与心梗预后的相关性.结果 多因素logistic回归分析显示,年龄[优势比(OR)=1.109,95％可信区间(95％ CI)为(1.073,1.147),P=0.000]、是否行急诊PCI[OR =4.162,95％ CI (1.980,8.748),P=0.000]、治疗前D-二聚体[OR=1.001,95％CI(1.000,1.002),P=0.001]、LVEF[OR=0.946,95％ CI (0.928,0.964),P=0.000]和治疗2hcTnⅠ[OR=1.011,95％CI(1.004,1.018),P=0.002]与28 d死亡相关.ROC曲线显示,年龄[曲线下面积(AUC)0.796、P=0.000]、是否行急诊PCI(AUC 0.704、P=0.000)、治疗前D-二聚体(AUC 0.797、P=0.000)与28 d死亡呈正相关,LVEF(AUC 0.261、P=0.000)与28 d死亡呈负相关;进一步绘制治疗前D-二聚体与发病至死亡时间及LVEF拟合曲线显示均不存在线性相关.结论 D-二聚体与心梗患者早期预后相关,但与发病至死亡时间并不存在线性关系;早期D-二聚体升高对提示心梗患者病情危重程度有帮助.     

创伤性脑损伤患者血清PCT，sTREM-1水平检测联合GCS评分对临床预后评估的价值

目的　探讨创伤性脑损伤（traumatic brain injury,TBI）患者血清降钙素原（procalcitonin,PCT）、可溶性髓样细胞触发受体-1（soluble triggering re ceptor-1,sTREM-1）水平检测联合格拉斯哥昏迷评分（Glasgow comd scale,GCS）对临床预后评估的价值。方法　选取2018年1月～2020年5月涿州市医院收治的TBI患者142例,根据28天预后情况分成存活组（n=110）和死亡组（n=32）。采用格拉斯哥昏迷评分（GCS）分为轻度组（n=10,13~15分）、中度组（n=79,9~12分）和重度组（n=53,3~8分）。比较各组血清PCT及sTREM-1水平,绘制受试者工作特征（ROC）曲线分析PCT,sTREM-1及GCS评分预测TBI患者死亡的价值。结果　死亡组血清PCT（1.91±1.06ng/ml vs 0.48±0.30ng/ml）及sTREM-1（60.28±9.74pg/ml vs 36.50±6.83pg/ml）水平均明显高于存活组,差异均有统计学意义（t=8.284, 8.117,均P<0.01）。重度组血清PCT（1.74±0.95ng/ml vs 0.63±0.38ng/ml）及sTREM-1（53.90±8.32pg/ml vs 42.70±7.26pg/ml）水平均明显高于轻中度组,差异具有统计学意义（t=7.506, 6.974,均P＜0.01）。ROC曲线分析显示,PCT,sTREM-1及GCS评分三项联合预测TBI患者死亡的曲线下面积（0.928,95%CI :0.870～0.991）最大,其敏感度和特异度分别为94.8%和87.0%。结论　血清PCT及sTREM-1水平升高与TBI患者的病情严重程度相关,联合GCS评分对TBI患者预后评估有较好的价值。     

血清S100B检测对创伤性脑损伤的诊断价值

目的 探讨血清S100钙结合蛋白B(S100B)在判断创伤性脑损伤(TBI)患者病情严重程度和预后评估中的应用价值.方法 选取该院救治的106例TBI患者,分别于伤后第1、3、5天检测血清S100B的水平;根据入院时的格拉斯哥昏迷评分(GCS)分为3组:轻度组65例、中度组14例、重度组27例;按照3个月时回访的格拉斯...     

Performance of the Pediatric Glasgow Coma Scale in Children with Blunt Head Trauma

Objectives: To compare the accuracy of a pediatric Glasgow Coma Scale (GCS) score in preverbal children with blunt head trauma with the standard GCS score in older children. Methods: The authors prospectively enrolled children younger than 18 years with blunt head trauma. Patients were divided into cohorts of those 2 years and younger and those older than 2 years. The authors assigned a pediatric GCS score to the younger cohort and the standard GCS score to the older cohort. Outcomes were 1) traumatic brain injury (TBI) on computed tomography (CT) scan or 2) TBI in need of acute intervention. The authors created and compared receiver operating characteristic (ROC) curves between the age cohorts for the association of GCS scores and TBI. Results: The authors enrolled 2,043 children, and 327 were 2 years and younger. Among these 327, 15 (7.7%; 95% confidence interval [CI] = 4.4% to 12.4%) of 194 who underwent imaging with CT had TBI visible and nine (2.8%; 95% CI = 1.3% to 5.2%) had TBI needing acute intervention. In children older than 2 years, 83 (7.7%; 95% CI = 6.2% to 9.5%) of the 1,077 who underwent imaging with CT had TBI visible and 96 (5.6%; 95% CI = 4.6% to 6.8%) had TBI needing acute intervention. For the pediatric GCS in children 2 years and younger, the area under the ROC curve was 0.72 (95% CI = 0.56 to 0.87) for TBI on CT scan and 0.97 (95% CI = 0.94 to 1.00) for TBI needing acute intervention. For the standard GCS in older children, the area under the ROC curve was 0.82 (95% CI = 0.76 to 0.87) for TBI on CT scan and 0.87 (95% CI = 0.83 to 0.92) for TBI needing acute intervention. Conclusions: This pediatric GCS for children 2 years and younger compares favorably with the standard GCS in the evaluation of children with blunt head trauma. The pediatric GCS is particularly accurate in evaluating preverbal children with blunt head trauma with regard to the need for acute intervention.     

Predictive value of d-dimer coupled with injury severity score in prognosis of trauma patients北大核心CSCD

Objective To investigate the value of D-dimer plus injury severity score (ISS) in predicting the prognosis of trauma patients. Methods The clinical data of 1 592 traumatic patients admitted to our emergency room from January 1, 2014 through December 31, 2016 were retrospectively analyzed. Excluding criteria included patients below the age of 14 and patients admitted over 24 h after injury, clinical death at admission, patients left from the hospital without the approval of attend doctor, detail and complete clinical data of patients not available, patients with history of coagulopathy, primary hepatic function failure, anticoagulants used within 6 months prior to injury, and patients with multiple injury affecting more than two parts of body. Finally, a total of 1 167 patients were enrolled in this study. The 28-day prognosis was used as the endpoint. The patients were divided into survival group and death group. The differences in venous plasma D-dimer and ISS at the first detection between two groups were compared by Mann-Whitney JJ test. According to ISS, the patients were divided into mild injury group, moderate injury group and severe injury group. The Kruskal-Wallis one-way ANOVA test was used to compare the differences among different groups. Meanwhile, the area under the ROC curve was used to compare the accuracy of predictive efficiency of D-dimer, ISS and the combination of both. Results There was a positive correlation between D-dimer and ISS, and D-dimer and ISS in survival group were significantly lower than those in death group(Z=-7.777, Z=-6.694, P <0.01). There was a statistically significant difference in mortality among groups 70.85, P <0.01); The area under the ROC curve of ISS, D-dimer and both combined was 0.728, 0.765, 0.800, respectively. The area under the ROC curve of D-dimer to predicte patients' prognosis was a little bit larger than that of ISS, but the difference was not statistically significant (Z= 1.051, /M).293). The area under the ROC curve of joint both of them for the prognosis of the patients was greater than that of ISS or D-dimer alone( Z=3.028, Z=2.722, P <0.05). Conclusions The levels of D-dimer and ISS in patients with traumatic injury are correlated with the severity and mortality of patients. The increased D-dimer and ISS score indicates that the risk of death is increased, and prediction efficiency of combining both of them is superior to either alone. © 2018 Chinese Medical Association. All rights reserved.     

血清冷诱导RNA结合蛋白与脓毒性休克患者病情严重程度及预后的相关性

目的探讨血清冷诱导RNA结合蛋白(CIRP)与脓毒性休克患者病情严重程度及预后的相关性。方法回顾性选取2018年1月至2020年1月海南医学院第二附属医院急诊重症监护室(EICU)收治的脓毒性休克患者107例为研究对象。收集患者一般资料、急性生理和慢性健康状况评估系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭估计(SOFA)评分、CIRP、血乳酸(Lac)、血清肌酐(s Cr)、血白细胞计数(WBC)、中性粒细胞百分比(NeuR)及降钙素原(PCT)。根据患者28 d预后情况将其分为死亡组和存活组。采用Pearson相关分析探讨脓毒性休克患者CIRP与SOFA评分及APACHEⅡ评分的相关性;采用Logistic回归分析探讨脓毒性休克患者28 d死亡的危险因素;绘制受试者工作特征(ROC)曲线并评估各指标对脓毒性休克患者28 d死亡的预测价值。结果随访28 d后,25例(23.4%)患者死亡(死亡组),82例(76.6%)患者存活(存活组)。死亡组APACHEⅡ评分、SOFA评分、CIRP、血Lac、s Cr及PCT水平明显高于存活组(P <0.05)。Pearson相关分析结果显示,脓毒性休克患者CIRP与SOFA评分及APACHEⅡ评分均呈正相关(r=0.337,P=0.005;r=0.249,P=0.039)。多因素Logistic回归分析结果显示,APACHEⅡ评分[OR=1.138,95%CI(1.066,1.214)]、SOFA评分[OR=1.326,95%CI(1.174,1.478)]、CIRP[OR=1.322,95%CI(1.141,1.502)]及PCT[OR=1.055,95%CI(1.003,1.108)]为脓毒性休克患者28 d死亡的危险因素(P <0.05)。CIRP、SOFA评分、APACHEⅡ评分、PCT预测脓毒性休克患者28 d死亡的ROC曲线下面积(AUC)分别为0.915[95%CI(0.823,0.969)]、0.834[95%CI(0.726,0.913)]、0.798[95%CI(0.684,0.885)]、0.685[95%CI(0.562,0.792)]。CIRP预测脓毒性休克患者28 d死亡的AUC大于SOFA评分、APACHEⅡ评分、PCT预测脓毒性休克患者28 d死亡的AUC(Z=2.134,P=0.041;Z=2.348,P=0.026;Z=3.64,P <0.001)。CIRP的最佳临界值为2.6μg/L时,预测脓毒性休克患者28 d死亡的敏感度为96.8%,特异度为73.7%。结论血清CIRP与脓毒性休克患者病情严重程度及预后密切相关,为28 d死亡的独立危险因素,可作为评价脓毒性休克患者预后的较好指标。     

A Comparison of Five Simplified Scales to the Out-of-hospital Glasgow Coma Scale for the Prediction of Traumatic Brain Injury Outcomes

Background: The 15-point Glasgow Coma Scale (GCS) frequently is used in the initial evaluation of traumatic brain injury (TBI) in out-of-hospital settings. We hypothesized that the GCS might be unnecessarily complex for out-of-hospital use.
Objectives: To assess whether a simpler scoring system might demonstrate similar accuracy in the prediction of TBI outcomes.
Methods: We performed a retrospective analysis of a trauma registry consisting of patients evaluated at our Level 1 trauma center from 1990 to 2002. The ability of out-of-hospital GCS scores to predict four clinically relevant TBI outcomes (emergency intubation, neurosurgical intervention, brain injury, and mortality) by using areas under receiver operating characteristic curves (AUROCs) was calculated. The same analyses for five simplified scales were performed, and compared with the predictive accuracies of the total GCS score.
Results: In this evaluation of 7,233 trauma patients over a 12-year period of time, the AUROCs for the total GCS score were 0.83 (95% confidence interval [CI] = 0.81 to 0.84) for emergency intubation, 0.86 (95% CI = 0.85 to 0.88) for neurosurgical intervention, 0.83 (95% CI = 0.82 to 0.84) for brain injury, and 0.89 (95% CI = 0.88 to 0.90) for mortality. The five simplified scales approached the performance of the total GCS score for all clinical outcomes.
Conclusions: In the evaluation of injured patients, five simplified neurological scales approached the performance of the total GCS score for the prediction of four clinically relevant TBI outcomes.     

视神经鞘直径预测重症脑损伤患者死亡风险的价值

目的:探讨超声测量视神经鞘直径（optic nerve sheath diameter,ONSD）对重症脑损伤患者死亡风险的预测价值。方法:本研究为前瞻性观察研究,分析2020年1月至2020年9月就诊安徽医科大学第二附属医院重症医学科的重症脑损伤患者84例。根据患者最终生存状态将其分为存活组和死亡组,比较两组患者术后...     

中重度颅脑外伤患者合并阵发性交感神经过度兴奋综合征的危险因素及对预后的影响

目的 分析在中重度颅脑外伤患者中与阵发性交感神经过度兴奋综合征（paroxysmal sympathetic hyperactivity,PSH）相关的危险因素,并分析PSH对此类患者预后的影响。方法 选择在我院收治的中重度颅脑外伤患者为研究对象。收集所有患者的人口学信息和临床诊治信息。按照是否合并PSH将患者分为PSH组（n=27）和对照组（n=99）,对相关变量进行回归分析,并分析PSH对中重度颅脑损伤预后［住院时间,住ICU时间,格拉斯哥预后评分(Glasgow Outcome Scale,GOS)］的相关性。结果 共纳入患者126 例（男性 82 例,女性 44例）,共有27例发生了PSH（21.4%）。与PSH发生相关的危险因素包括入院时收缩压>140 mmHg(1 mmHg=0.133 kPa)（OR=3.21,95%CI=1.31~7.87,P=0.011）,GCS<8分(OR=4.34,95%CI=1.73~10.93,P=0.002),创伤后急诊CT提示存在脑挫裂伤（OR=4.29,95%CI=2.55~8.26,P<0.001）,颅内出血量≥50 ml（OR=2.33,95%CI=1.42~5.13,P=0.003）以及后期出现脑积水(OR=3.57,95%CI=1.36~9.37,P=0.010)。而PSH又与住院时间>1个月（OR=5.21,95%CI=2.88~7.42,P=0.002）和GOS 1~3分有关（OR=1.75,95%CI=1.24~3.78,P=0.009）。结论 PSH是中重度颅脑外伤患者的一种常见并发症。PSH的发生与入院时收缩压较高、GCS较低、合并脑挫伤以及后期合并脑积水等因素密切相关,而合并PSH的患者住院时间更长,预后更差。     

Traumatic brain injury: Association between the Glasgow Coma Scale score and intensive care unit mortality

Background Traumatic brain injury (TBI) prevalence in Botswana is high and this, coupled with a small population, may reduce productivity. There is no previous study in Botswana on the association between mortality from TBI and the Glasgow Coma Scale (GCS) score although global literature supports its existence. Objectives Our primary aim was to determine the association between the initial GCS score and the time to mortality of adults admitted with TBI at the Princess Marina Hospital, Gaborone, Botswana, between 2014 and 2019. Secondary aims were to assess the risk factors associated with time to mortality and to estimate the mortality rate from TBI. Methods This was a retrospective cohort design, medical record census conducted from 1 January 2014 to 31 December 2019. Results In total, 137 participants fulfilled the inclusion criteria, and the majority, 114 (83.2%), were male with a mean age of 34.5 years. The initial GCS score and time to mortality were associated (adjusted hazard ratio (aHR) 0.69; 95% confidence interval (CI) 0.508 - 0.947). Other factors associated with time to mortality included constricted pupil (aHR 0.12; 95% CI 0.044 - 0.344), temperature (aHR 0.82; 95% CI 0.727 - 0.929), and subdural haematoma (aHR 3.41; 95% CI 1.819 - 6.517). Most cases of TBI (74 (54%)) were due to road traffic accidents. The number of deaths was 48 (35% (95% CI 27.1% - 43.6%)), entirely due to severe TBI. Conclusion The study confirmed significant association between GCS and mortality. Males were mainly involved in TBI. These findings lack external validity because of the small sample size, and therefore a larger multicentre study is required for validation. Contributions of the study This study informs the relevant stakeholders in Botswana about sociodemographics, clinical characteristics, management and outcomes of patients admitted to the ICU with severe TBI on the backdrop of scarce ICU resources. It provides a basis for a larger study to inform its external validation.