护理干预引起重型颅脑损伤继发性脑损害的预测因子分析

目的 探讨重型颅脑损伤（TBI）病人发生护理干预相关的继发性脑损害的风险预测因子。方法 回顾性分析28例重型TBI临床资料，护理干预包括体位护理和卫生护理。预测因子包括基线颅内压（ICP）≥15 mmHg、脑血管压力反应指数（PRx）≥0.3或ICP幅度≥6 mmHg。ICP≥20 mmHg持续5 min以上定义为继发性脑损害。结果 28例共记录67次护理干预，其中体位护理49次，卫生护理18次。12例35次护理干预ICP<20 mmHg；10例24次护理干预出现一过性ICP≥20 mmHg；6例8次护理干预出现继发性脑损害，发生率为11.94%（8/67）。基线ICP≥15 mmHg病人继发性脑损害发生率明显增高（P<0.05）。基线ICP≥15 mmHg预测护理干预相关性继发性脑损害的特异性为86.4%，敏感性为50.0%，阳性预测值为33.3%，阴性预测值为92.7%。结论 基线ICP≥15 mmHg是决定重型颅脑损伤护理干预后继发性脑损害风险的最重要因素。

Analysis of predictors of secondary cerebral injury in patients with severe traumatic brain injury caused by nursing intervention

Objective To explore the predictors of secondary cerebral injury in patients with severe traumatic brain injury (sTBI) caused by nursing intervention. Methods The clinical data of 28 patients with sTBI were retrospectively analyzed. The nursing intervention included repositioning and hygienic interventions. The predictors included baseline ICP ≥15 mmHg, cerebrovascular pressure response index (PRx) ≥0.3 or ICP amplitude ≥6 mmHg. The secondary cerebral injury was defined as sustained ICP of 20 mmHg or greater for 5 minutes or more. Results A total of 67 times of nursing interventions were recorded in 28 patients, including 49 times of repositioning and 18 times of hygienic interventions. The ICP<20 mmHg occurred in 35 times of nursing intervention of 12 patients, temporary ICP ≥ 20 mmHg occurred in 24 times nursing intervention of 10 patients and the secondary cerebral injury occurred in 8 times of nursing intervention of 6 patients. The incidence of the secondary cerebral injury was 11.94% (8/67). The incidence of the secondary cerebral injury was significantly higher in patients with baseline ICP≥15 mmHg than those with baseline ICP<15 mmHg (P<0.05). The baseline ICP≥15 mmHg had good predictive effect on the secondary cerebral injury, with a specificity of 86.4%, a sensitivity of 50.0%, a positive predictive value of 33.3% and a negative predictive value of 92.7%. Conclusion The baseline ICP≥15 mmHg is the most important factor in determining the risk of the secondary cerebral injury after nursing intervention in patients with sTBI.