Acute physiology and chronic health evaluation (APACHE II) and Glasgow coma scores as predictors of outcome from intensive care after cardiac arrest

OBJECTIVES: a) To examine the accuracy of the Acute Physiology and Chronic Health Evaluation (APACHE II) and the Glasgow Coma Scores as predictors of the outcome of patients following resuscitation from cardiac arrest; b) to study the impact of the components of APACHE II on the prediction. DESIGN: A nationwide study in Finland with prospectively collected data on all patients admitted to intensive care after cardiac arrest during a 14-month period. Two thirds of the cardiac arrest patients included in the study were randomly selected to derive predictive models, and the remaining one third constituted the validation sample. SETTING: A total of 25 medical and surgical ICUs in Finland (13 in tertiary referral centers). PATIENTS: Six-hundred nineteen consecutive cardiac arrest patients. Fifteen patients less than 16 yrs were excluded. MAIN OUTCOME MEASURES: Variables included in the APACHE II or Glasgow Coma Scores were collected at the time of ICU admission and then three times after admission, at 24-hr intervals. ICU- and hospital-mortality rates and a 6-month mortality rate after ICU admission were studied. RESULTS: Of 604 study patients, 370 (61.3%) patients died in the hospital. The most accurate prediction of hospital outcome was based on data collected after the first day of ICU care, not on the admission values. Twenty-one (21.9%) of 96 patients with a low APACHE II score (less than or equal to 9) died compared with 66 (84.6%) of 78 patients with a high APACHE II score (greater than or equal to 25) (p less than .001). Of 160 patients with a normal Glasgow Coma Score (14 to 15), 45 (28.1%) died, whereas there were 114 (81.4%) nonsurvivors among 140 patients with a low Glasgow Coma Score of 3 (p less than .001). The performance of predictive models, including age, the Chronic Health Evaluation, and either the Acute Physiology Score (Acute Physiology Score model) or the Glasgow Coma Score (Glasgow Coma Score model) were compared with the prediction according to the APACHE II in the validation sample. When using 80% probability of death as a decision rule, the Acute Physiology Score model determined 35 of 153 patients to have high risk of death, 29 of whom died (the positive predictive value being 82.9%). The Glasgow Coma Score model predicted 34 patients to die, 26 of whom died (positive predictive value 76.5%), and the APACHE II score predicted seven deaths, five of whom actually died (positive predictive value 71.4%). CONCLUSIONS: The APACHE II scoring system cannot be recommended as a prognostic tool to support clinical judgement in cardiac arrest patients, but by modifying it, a more accurate prediction of poor outcome could be achieved. The Glasgow Coma Score explained to a great extent the predictive power of the APACHE II.     

重度脑外伤后动态监测局部脑氧饱和度的临床意义

目的 探讨重度脑外伤(sTBI)后,动态监测局部脑氧饱和度(SctO₂)的临床意义。 方法 2017年12月至2019年1月,sTBI后24 h内患者33例,采用近红外光谱技术每6小时监测SctO₂、颅内压(ICP)和脑灌注压(CPP),共7 d,记录入院时格拉斯哥昏迷评分(GCS)和伤后6个月格拉斯哥预后评分(GOS)。 结果 SctO₂于监测第3天最低,随后逐渐升高;SctO₂与ICP呈负相关(r < -0.857, P < 0.001),与GCS、CPP、GOS呈正相关( r > 0.697, P < 0.001)。 结论 sTBI后SctO₂监测可早期识别部分继发性损伤,判断疾病严重程度,并部分预测疾病结局。     

Predicting six-month mortality of patients with traumatic brain injury: usefulness of common intensive care severity scores

Introduction

The aim of this study was to evaluate the usefulness of the APACHE II (Acute Physiology and Chronic Health Evaluation II), SAPS II (Simplified Acute Physiology Score II) and SOFA (Sequential Organ Failure Assessment) scores compared to simpler models based on age and Glasgow Coma Scale (GCS) in predicting long-term outcome of patients with moderate-to-severe traumatic brain injury (TBI) treated in the intensive care unit (ICU).

Methods

A national ICU database was screened for eligible TBI patients (age over 15 years, GCS 3–13) admitted in 2003–2012. Logistic regression was used for customization of APACHE II, SAPS II and SOFA score-based models for six-month mortality prediction. These models were compared to an adjusted SOFA-based model (including age) and a reference model (age and GCS). Internal validation was performed by a randomized split-sample technique. Prognostic performance was determined by assessing discrimination, calibration and precision.

Results

In total, 1,625 patients were included. The overall six-month mortality was 33%. The APACHE II and SAPS II-based models showed good discrimination (area under the curve (AUC) 0.79, 95% confidence interval (CI) 0.75 to 0.82; and 0.80, 95% CI 0.77 to 0.83, respectively), calibration (P > 0.05) and precision (Brier score 0.166 to 0.167). The SOFA-based model showed poor discrimination (AUC 0.68, 95% CI 0.64 to 0.72) and precision (Brier score 0.201) but good calibration (P > 0.05). The AUC of the SOFA-based model was significantly improved after the insertion of age and GCS (∆AUC +0.11, P < 0.001). The performance of the reference model was comparable to the APACHE II and SAPS II in terms of discrimination (AUC 0.77; compared to APACHE II, ΔAUC −0.02, P = 0.425; compared to SAPS II, ΔAUC −0.03, P = 0.218), calibration (P > 0.05) and precision (Brier score 0.181).

Conclusions

A simple prognostic model, based only on age and GCS, displayed a fairly good prognostic performance in predicting six-month mortality of ICU-treated patients with TBI. The use of the more complex scoring systems APACHE II, SAPS II and SOFA added little to the prognostic performance.     

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...     

Reliability and validity of the Pediatric Intensity Level of Therapy (PILOT) scale: a measure of the use of intracranial pressure-directed therapies

OBJECTIVE: To test the reliability and validity of the Pediatric Intensity Level of Therapy (PILOT) scale, a novel measure of overall therapeutic effort directed at controlling intracranial pressure (ICP) in the setting of severe (Glasgow Coma Scale of 相似文献   

Impact of non-neurological complications in severe traumatic brain injury outcome

ABSTRACT: INTRODUCTION: Non-neurological complications in patients with severe traumatic brain injury (TBI) are frequent, worsening the prognosis, but the pathophysiology of systemic complications after TBI is unclear. The purpose of this study was to analyze non-neurological complications in patients with severe TBI admitted to the ICU, the impact of these complications on mortality, and their possible correlation with TBI severity. METHODS: An observational retrospective cohort study was conducted in one multidisciplinary ICU of a university hospital (35 beds); 224 consecutive adult patients with severe TBI (initial Glasgow Coma Scale (GCS) < 9) admitted to the ICU were included. Neurological and non-neurological variables were recorded. RESULTS: Sepsis occurred in 75% of patients, respiratory infections in 68%, hypotension in 44%, severe respiratory failure (arterial oxygen pressure/oxygen inspired fraction ratio (PaO2/FiO2) < 200) in 41% and acute kidney injury (AKI) in 8%. The multivariate analysis showed that Glasgow Outcome Score (GOS) at one year was independently associated with age, initial GCS 3 to 5, worst Traumatic Coma Data Bank (TCDB) first computed tomography (CT) scan and the presence of intracranial hypertension but not AKI. Hospital mortality was independently associated with initial GSC 3 to 5, worst TCDB first CT scan, the presence of intracranial hypertension and AKI. The presence of AKI regardless of GCS multiplied risk of death 6.17 times (95% confidence interval (CI): 1.37 to 27.78) (P < 0.02), while ICU hypotension increased the risk of death in patients with initial scores of 3 to5 on the GCS 4.28 times (95% CI: 1.22 to15.07) (P < 0.05). CONCLUSIONS: Low initial GCS, worst first CT scan, intracranial hypertension and AKI determined hospital mortality in severe TBI patients. Besides the direct effect of low GCS on mortality, this neurological condition also is associated with ICU hypotension which increases hospital mortality among patients with severe TBI. These findings add to previous studies that showed that non-neurological complications increase the length of stay and morbidity in the ICU but do not increase mortality, with the exception of AKI and hypotension in low GCS (3 to 5).     

Plasma interleukin-8 as a potential predictor of mortality in adult patients with severe traumatic brain injury

Because of complex pathophysiology and severe consequences, traumatic brain injuries (TBI) are an important medical problem. Pathophysiology of TBI includes local and systemic stress response, in which interleukin-8 (IL-8) is considered as a key mediator of neuroinflammation. However, prognostic relevance of IL-8 measurement in adult patients with severe TBI is not certain. Therefore, IL-8 was determined in blood samples from central venous and jugular bulb catheter and in cerebrospinal fluid of twenty patients with isolated TBI at admission to Intensive Care Unit. None of the patients had history of stroke, dementia, autoimmune diseases, acute infection or medication with anti-inflammatory drugs. Ten patients died due to traumatic brain injury, while the other ten recovered well. While there was no significant difference of IL-8 levels in cerebrospinal fluid between survivors and nonsurvivors, central venous plasma level of IL-8 was significantly lower in survivors (71.00 +/- 14.17 pg/ml), than in nonsurvivors (111.26 +/- 16.9 pg/ml). Receiver Operating Characteristic (ROC) analysis revealed significant prognostic value for IL-8 in the blood as well as for the age of patients, Glasgow Coma Scale (GCS) and Acute Physiologic and Chronic Health Evaluation (APACHE II). These findings suggest that the central venous plasma values of IL-8 at admission might be an early predictive marker in patients with severe TBI, comparative to standard clinical prognostic markers such as APACHE II and GCS.     

颅脑损伤患者远期生存质量评估－改良功能生活指数

目的评估颅脑损伤患者伤后不同时期的生存质量。方法颅脑外伤患者122例中获得85例随访。使用GCS、GOS和KPS等作为参照,同时使用专用于颅脑外伤的RFLI(改良功能生活指数)量表,由患者自行填写评估。结果RFLI与GOS,GCS,KPS均有很好的相关性。结论颅脑外伤的生存质量与其主观感受存在显著的相关性,一种多维评估量表,也可用于各种治疗手段的疗效评价。     

亚低温状态下大剂量硫酸镁治疗弥漫性轴索损伤的临床研究

目的观察联合使用亚低温及大剂量硫酸镁治疗弥漫性轴索损伤的临床效果.方法64例诊断为弥漫性轴索损伤,GCS评分为3～8的患者被随机分为治疗组和对照组.治疗组的患者入院20 min后给予静注24 mmol硫酸镁,再用80 mmol持续24 h静滴,同时自伤后6 h开始联合用亚低温治疗,使直肠温度控制在33～35 ℃,治疗时间为3～5 d,对照组按普通常规治疗.两组患者均于入院当天、治疗后3d和7d测血清神经元特异性异烯醇化酶(NSE)和GCS,出院和3个月后测GOS.结果 治疗组和对照组的血清NSE,GCS 和GOS分别为(24.8±19.2)g/L,12.3±3.3,4.6±1.3和(49.7±23.1)g/L,9.8±2.8,3.0±1.5,两组差异有显著性(P＜0.01).结论 联合使用亚低温和大剂量硫酸镁治疗弥漫性轴索损伤有明显疗效.     

Comparison of the Glasgow Coma Scale and the Reaction Level Scale for assessment of cerebral responsiveness in the critically ill

OBJECTIVE: The Glasgow Coma Scale (GCS) is a well-known source of error in outcome prediction models. We compared assessment of cerebral responsiveness with the GCS and the Reaction Level Scale (RLS) in two otherwise similar outcome prediction models. DESIGN AND SETTING: Prospective, observational study in a general intensive care unit. PATIENTS AND PARTICIPANTS: All admissions of patients with or at risk of developing impaired brain function between 1997 and 1998 ( n=534). MEASUREMENTS AND RESULTS: Admissions were scored by RLS and APACHE II (includes scoring with the GCS). The RLS scores were transformed to APACHE II central nervous system scores according to a predetermined protocol. APACHE II estimated probability of death was calculated conventionally with the GCS and the RLS. Vital status 90 days after admission was secured from a national database. Bias and precision was 0.5% and 16.6%, respectively. The area under receiver operating characteristic curves was slightly but significantly greater with the RLS-based APACHE II model than with the GCS-based model (0.92 vs. 0.90). Discrimination was improved primarily in admissions with low and intermediate probability of death. CONCLUSIONS: Scoring of cerebral responsiveness with the RLS instead of the GCS was associated with minimal bias of the APACHE II probability of death estimate. Assessment of consciousness in critically ill with the RLS deserves further evaluation     

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。     

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。     

Should the pre-sedation Glasgow Coma Scale value be used when calculating Acute Physiology and Chronic Health Evaluation scores for sedated patients? Scottish Intensive Care Society Audit Group

OBJECTIVE: To assess the effect on the performance of Acute Physiology and Chronic Health Evaluation (APACHE) II and APACHE III of two different approaches to scoring the Glasgow Coma Scale (GCS) in sedated patients. The first approach was to assume that the GCS score was normal, and the second was to use the GCS value recorded before the patient was sedated. DESIGN: Prospective cohort study over 2 yrs. SETTING: Twenty-two general adult intensive care units in Scotland. PATIENTS: 13,291 consecutive admissions to the participating intensive care units. MEASUREMENTS AND MAIN RESULTS: After exclusion of patients according to standard, predefined criteria, the Acute Physiology and Chronic Health Evaluation II and III systems were used to calculate the probability of hospital mortality for patients included in the study. In patients whose GCS scores could not be assessed accurately during the first 24 hrs, the APACHE II and III predictions were calculated twice: first, assuming that the GCS score was normal; and second, substituting the GCS score recorded before sedation. This generated two different databases for each system, and the predictions for both were compared with the observed hospital mortality rate. The effect of the two different approaches to the GCS on the performance of both APACHE II and APACHE III was assessed using measures of discrimination (area under the receiver operating characteristic curve) and goodness of fit (calibration curves and the Hosmer-Lemeshow statistic). Analysis was undertaken for both the entire cohort and for the group of patients whose APACHE scores were altered. There was a wide variation in the number of patients who had their scores altered between participating units. There were also differences between diagnostic groups. Overall, however, 50% of the patients were sedated and 22% had their scores altered. Using the presedation GCS score increased the discrimination of both APACHE II and APACHE III. The calibration of APACHE III was also improved but that of APACHE II deteriorated. The calibration improved, however, in those patients with altered scores, suggesting that the overall deterioration is attributable to other limitations in the fit of the model to these data. Although changes had the greatest effect in patients with a neurologic or trauma diagnosis, the changes were important in most diagnostic groups. CONCLUSIONS: The GCS is an important component of both APACHE II and APACHE III. It should be assessed directly whenever possible. When patients are sedated, using the GCS score recorded before sedation is preferable to the assumption of normality. The variations between different units and different diagnostic groups highlight the possible effects of case mix on the performance of prognostic scoring systems.     

Intensive care unit morbidity and mortality from eclampsia: an evaluation of the Acute Physiology and Chronic Health Evaluation II score and the Glasgow Coma Scale score

OBJECTIVE: To determine the maternal morbidity and mortality in patients with eclampsia admitted to an intensive care unit (ICU), and to establish the efficacy of the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the organ system failure score as defined by Knaus, and the Glasgow Coma Scale (GCS) score in predicting outcome. DESIGN: Retrospective analysis of a 3.5-yr period. SETTING: Surgical ICU in a university hospital. PATIENTS: A total of 105 patients who were admitted with a diagnosis of eclampsia were studied. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The data captured included the reason for admission, maternal age, gestational age, parity, number of seizures, duration of ICU stay, anticonvulsant therapy, drug therapy, GCS score, APACHE II score, and the occurrence of organ failure. Of the 126 patients with eclampsia who were admitted to the ICU, records of 105 patients (83%) were found. The overall mortality was 10.5% (n = 11). The mean age, gestation, parity, number of preadmission seizures, and duration of stay were similar in survivors and nonsurvivors. Although the APACHE II score was significantly higher in nonsurvivors, multiple logistic regression analysis suggested that the goodness-of-fit scores for GCS and APACHE II were similar (38.29 vs. 38.01). The GCS scores of survivors were significantly higher than those of nonsurvivors (10.61 vs. 5.0; p<.001). Respiratory failure was the most common organ failure in both groups. The mean number of organ failures was higher in nonsurvivors compared with survivors (2.9 vs. 1.3; p<.001). An occurrence of more than two organ failures that persisted for >48 hrs was invariably associated with a fatal outcome. Anticonvulsant therapy consisted of magnesium sulfate or phenytoin and a midazolam infusion. Only one patient (0.9%) had a seizure, and this occurred en route to the ICU. No seizures occurred after admission to the ICU. CONCLUSIONS: The organ system failure score and the GCS score are good predictors of outcome in eclampsia. Apart from the GCS score, other variables in the APACHE II score are not valuable for outcome prediction. The low GCS score in nonsurvivors suggests that closer attention to the neurologic management may be beneficial. A prospective study is indicated to validate these findings.     

高渗盐水可降低重型颅脑创伤患者颅内压

目的:评价高渗盐水和甘露醇降低重型颅脑创伤患者颅内压(ICP)的效果。方法:我院治疗的重型颅脑损伤患者132例,随机分为高渗盐水组65例和甘露醇组67例,在常规治疗基础上,分别给予3%高渗盐水5.4 mL/kg和20%甘露醇5.0 mL/kg静脉滴注。评价2组治疗期间的药物起效时间、最大ICP下降幅度、累积颅内压负荷(CICPB)、平均ICP负荷时间、压力累及时间(PTD)、ICU停留时间和格拉斯哥预后评分(GOS)。结果:2组起效时间、最大ICP下降幅度组间比较差异无统计学意义(P0.05);高渗盐水组PTD、CICPB和ICP负荷时间均小于甘露醇组(P0.05);2组ICU停留时间、GOS评分和临床预后差异无统计学意义(P0.05)。以GOS评分为因变量的多元线性回归分析结果显示,PTD、CICPB、ICP负荷时间与GOS呈负相关(P0.05),起效时间、最大ICP下降幅度与GOS不相关(P0.05)。结论:高渗盐水稳定重型颅脑损伤患者ICP的效果优于甘露醇,但不能改善临床预后。     

Event-related potentials — neurophysiological tools for predicting emergence and early outcome from traumatic coma

Objective To determine the prognostic value of multimodal evoked potentials (EPs) and eventrelated (ERPs) potentials in coma (Glasgow Coma Score <8), after severe traumatic brain injury (TBI).Design Prospective, longitudinal study of neurophysiological responses recorded during traumatic coma.Setting Intensive Care Unit, Frenchay Hospital, Bristol, UK.Participants Fifty-four comatose TBI patients (age range 1–80 years, mean 36.4).Methods Neurophysiological responses were recorded from 11 scalp electrodes with earlobe reference. Conduction times were measured for brainstem auditory, flash visual and somatosensory, shortlatency EPs. Peak latencies and amplituides were determined for long-latency components of visual and auditory ERPs, generated by passive oddball paradigms. These neurophysiological and various clinical parameters were correlated with patient outcome using Pearson's coefficient.Main outcome measure Three month Glassgow Outcome Scale (GOS).Results and conclusion Highly significant (P<0.001) correlations exist between long-latency ERP components and 3-month outcome. Short-latency EPs, brainstem (wave I–V) and somatosensory conduction times, also correlate significantly with the GOS (P<0.01). Of the clinical measurements, pupillary response patterns, APACHE II and Glasgow Coma Scores (GCS) correlate significantly with outcome, as do the retrospective measures of duration of coma and post-traumatic amnesia (PTA) in survivors. Unfortunately, due to variance of long-latency responses, even in controls, absolute values cannot be relied upon as prognosticators. The presence of mismatch negativity predicted the return of consciousness (89.7% sensitivity and 100% specificity) and preceded changes in GCS. Its latency was the single best indicator of 90-day outcome from coma (r=–0.641).     

复温速度对重症颅脑外伤亚低温神经保护的初步研究

目的探讨不同复温速度对重症颅脑外伤亚低温神经保护作用的影响。方法将39例亚低温治疗的重症颅脑外伤患者随机分为Ⅰ组(n=13,复温速度0.1℃/h)、Ⅱ组(n=13,复温速度0.2℃/h)及Ⅲ组(n=13,复温速度0.3℃/h)。治疗过程中动态监测颅内压、心率、血压、脉氧饱和度,每日测定血糖、血细胞分析、血气分析、凝血功能、肝肾功能、电解质,每日进行GCS评分,并于伤后3个月根据格拉斯哥预后分级(GOS)评定疗效。结果复温达36.5℃时及达标后24 hⅢ组颅内压监测(ICP)明显高于Ⅰ组,有统计学意义(P<0.05);复温达标后72 h GCSⅠ组、Ⅱ组均高于Ⅲ组,有统计学意义(P<0.05),Ⅰ组高于Ⅱ组,但无统计学意义;3个月时Ⅰ组、Ⅱ组GOS明显优于Ⅲ组(P<0.05),Ⅰ组与Ⅱ组间比较无明显差异;复温达36.5℃时及达标后24 hⅢ组血糖明显高于Ⅰ组和Ⅱ组,差异有统计学意义(P<0.05)。结论较慢的复温速度可改善脑灌注,减轻脑水肿,有效保护神经功能并改善预后。     

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。     

Serum S 100 B: a marker of brain damage in traumatic brain injury with and without multiple trauma

This prospective clinical study was conducted to determine whether S 100 B is a reliable serum marker for traumatic brain injury (TBI) with and without multiple trauma. Fifty-five trauma patients (Injury Severity Score [ISS] > or = 24 and Glasgow Coma Score [GCS] < or = 8) were classified by radiography, computer tomography, ultrasound, and neurology as TBI without multiple trauma (n = 23), TBI with multiple trauma (n = 23), or multiple trauma without TBI (n = 9). S 100 B was measured initially after trauma and daily for a maximum of 21 days. Both survivors and nonsurvivors had markedly increased S 100 B initially. All survivors returned to normal or moderately increased S 100 B levels within the first 48 h after trauma. In contrast, all nonsurvivors of isolated TBI had S 100 B values that either increased consistently or dropped and then increased again 48 h after the initial increase after trauma. There was no relationship between localization, extent, or severity of TBI and S 100 B. According to receiver operating characteristic curve analysis and calculation of the area under the curve (AUC), S 100 B is equally accurate for mortality prediction at 24, 48, and 72 h after trauma and is most accurate >84 h after trauma. Sensitivity/specificity for mortality prediction are more accurate in TBI without multiple trauma (AUC 0.802-0.971) than in TBI with multiple trauma (AUC 0.693-0.783). Thus, though S 100 B may be a reliable marker of brain damage in TBI without multiple trauma 24 h after trauma and thereafter, it appears to be less reliable in TBI with multiple trauma.     

持续颅内压和脑组织氧分压联合监测在高血压性脑出血手术前后的应用

目的 探讨持续颅内压(ICP)监测联合脑组织氧分压(PbtO2)监测在高血压性脑出血(HICH)患者小骨窗血肿清除术前后的应用及对患者预后的影响.方法 回顾性分析2018年9月至2020年10月内蒙古自治区人民医院神经外科神经重症病房收治的幕上HICH行小骨窗脑内血肿清除术27例患者的临床资料.患者均于术前植入ICP及...