摘要
目的分析急性重型颅脑损伤早期预后的影响因素及中性粒细胞与淋巴细胞比值(NLR)、神经元特异性烯醇化酶(NSE)、脑电双频指数(BIS)联合急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分的预测价值。方法回顾性纳入新疆医科大学第一附属医院收治的238例急性重型颅脑损伤患者的临床资料,纳入病例时间为2021年8月—2023年8月,根据患者伤后30 d格拉斯哥预后量表(GOS)评分,将患者划分为两组:其中预后良好者149例,预后不良者89例。结果预后不良组入院时瞳孔散大、中线位移>5 mm、环池受压、格拉斯哥昏迷量表(GCS)评分为3~8分的患者占比及血清C反应蛋白(CRP)、NSE、NLR值、APACHEⅡ评分均高于预后良好组,外周血血红蛋白(HGB)水平、BIS值低于预后良好组(均P<0.05)。Logistic回归分析结果显示,急性重型颅脑损伤早期预后的影响因素包括入院时瞳孔散大、中线位移>5 mm、环池受压、NLR值高、血清NSE水平高、BIS值低、APACHEⅡ评分高、GCS评分为3~8分(均P<0.05)。NLR、NSE、BIS、APACHEⅡ评分及联合检查预测急性重型颅脑损伤早期预后的曲线下面积(AUC)分别为0.818、0.809、0.763、0.797、0.953,其中联合检测的诊断价值最高。结论入院时瞳孔散大、中线位移>5 mm、环池受压、血清CRP、NSE、NLR值、APACHEⅡ评分是急性重型颅脑损伤早期预后的影响因素,其中NLR、NSE、BIS、APACHEⅡ评分四者联合对预后的预测价值较高。
Objective To analyze the influencing factors of early prognosis of acute severe craniocerebral injury and the predictive value of neutrophil-lymphocyte ratio(NLR),neuron-specific enolase(NSE),bispectral index(BIS)combined with acute physiological and chronic health evaluation ofⅡ(APACHEⅡ).Methods The clinical data of 238 patients diagnosed with acute severe craniocerebral injury in the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed.The time of inclusion was from August 2021 to August 2023.They were divided into two groups:149 patients with good prognosis and 89 patients with poor prognosis.The patients were divided into two groups by Glasgow outcome scale(GOS)30 days after injury.Results The proportion of patients with dilated pupils,midline displacement>5 mm,compression of cisterna cisterna,Glasgow coma scale(GCS)score of 3-8,serum C-reactive protein(CRP),NSE level,NLR value and APACHEⅡscore in poor prognosis group were higher than those in good prognosis group,while peripheral blood HGB level and BIS value were lower in good prognosis group(all P<0.05).Logistic regression analysis showed that the independent factors affecting the early prognosis of acute severe craniocerebral injury included dilated pupils at admission,midline displacement>5 mm,compression of cistern,high NLR value,high level of serum NSE,low BIS value,high score of APACHEⅡand the score of GCS was 3-8(all P<0.05).The area under the curve(AUC)of NLR,NSE,BIS,score of APACHEⅡand combined examination in predicting the early prognosis of acute severe craniocerebral injury were 0.818,0.809,0.763,0.797 and 0.953,and the diagnostic value of combined examination was the highest.Conclusion The proportion of patients with dilated pupils,midline displacement>5 mm,and compression of cisterna circumlocularis at admission,serum CRP,NSE level,NLR value and APACHEⅡscores are the influencing factors for the early prognosis of acute severe craniocerebral injury.The combined examination of NLR,NSE,BIS and APACHEⅡscores had high diagnostic value in predicting the early prognosis of patients with acute severe craniocerebral injury.
作者
龚雪
熊小平
赵莉
杜文妍
GONG Xue;XIONG Xiaoping;ZHAO Li;DU Wenyan(Department of Respiratory Intensive Care Medicine,The First Affiliated Hospital of Xinjiang Medical University,Urumqi Xinjiang Uygur Autonomous Region 830000,China)
出处
《中国急救复苏与灾害医学杂志》
2026年第1期97-101,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
