目的探讨rSIG(the reverse shock index multiplied by Glasgow coma scale score)与动脉血乳酸(Lac)对重型颅脑创伤患者预后评估的价值。方法回顾性分析某院急诊抢救室2016年8月至2019年9月收治的120例重型颅脑创伤患者的临床资料,以...目的探讨rSIG(the reverse shock index multiplied by Glasgow coma scale score)与动脉血乳酸(Lac)对重型颅脑创伤患者预后评估的价值。方法回顾性分析某院急诊抢救室2016年8月至2019年9月收治的120例重型颅脑创伤患者的临床资料,以外伤后28 d预后情况为标准,将患者分为生存组(81例)和死亡组(39例)。比较两组患者的临床资料;分析影响重型颅脑创伤患者死亡的危险因素;分析rSIG与动脉血Lac及两者联合对重型颅脑创伤患者预后的预测价值。结果存活组的收缩压、舒张压、平均动脉压、GCS评分及rSIG均明显高于死亡组,动脉血Lac水平明显低于死亡组,差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示,收缩压、GCS评分、rSIG、动脉血Lac是重型颅脑创伤患者死亡的独立危险因素(P<0.05)。rSIG联合动脉血Lac对重型颅脑创伤患者死亡率的预测能力优于rSIG(P<0.05),但与动脉血Lac比较(P>0.05)。结论rSIG、动脉血Lac是重型颅脑创伤患者预后相关的独立危险因素,且对重型颅脑创伤患者伤情严重程度及预后有较好的预测价值。展开更多
This review summarizes the current research advances and guideline updates in neurocritical care. For the therapy of ischemic stroke, the extended treatment time window for thrombectomy and the emergence of novel thro...This review summarizes the current research advances and guideline updates in neurocritical care. For the therapy of ischemic stroke, the extended treatment time window for thrombectomy and the emergence of novel thrombolytic agents and strategies have brought greater hope for patient recovery. Minimally invasive hematoma evacuation and goal-directed bundled management have shown clinical benefits in treating cerebral hemorrhage. In the treatment of aneurysmal subarachnoid hemorrhage (aSAH), early lumbar drainage can reduce the risk of infarction. Decompressive craniectomy for severe traumatic brain injury has also obtained high-quality evidence support. However, multimodal brain monitoring strategies for patients with traumatic brain injury need further optimization. For patients with cardiac arrest, extracorporeal cardiopulmonary resuscitation can reduce in-hospital mortality and improve long-term neurological prognosis. For neurocritical care patients, abundant high-quality studies have emerged in areas including multimodal neuromonitoring, hemodynamic management, airway management and respiratory therapy, and antiepileptic treatment. In 2023, the guidelines for aSAH have been updated for the first time in the past decade, aiming to provide evidence-based practice recommendations for clinical care. Chinese expert consensuses have also been formulated to guide analgesia and sedation for neurocritical care patients and developed a set of medical quality indicators on neurocritical care, which will enhance standardization and homogenization improvement in neurocritical care quality.展开更多
文摘目的探讨rSIG(the reverse shock index multiplied by Glasgow coma scale score)与动脉血乳酸(Lac)对重型颅脑创伤患者预后评估的价值。方法回顾性分析某院急诊抢救室2016年8月至2019年9月收治的120例重型颅脑创伤患者的临床资料,以外伤后28 d预后情况为标准,将患者分为生存组(81例)和死亡组(39例)。比较两组患者的临床资料;分析影响重型颅脑创伤患者死亡的危险因素;分析rSIG与动脉血Lac及两者联合对重型颅脑创伤患者预后的预测价值。结果存活组的收缩压、舒张压、平均动脉压、GCS评分及rSIG均明显高于死亡组,动脉血Lac水平明显低于死亡组,差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示,收缩压、GCS评分、rSIG、动脉血Lac是重型颅脑创伤患者死亡的独立危险因素(P<0.05)。rSIG联合动脉血Lac对重型颅脑创伤患者死亡率的预测能力优于rSIG(P<0.05),但与动脉血Lac比较(P>0.05)。结论rSIG、动脉血Lac是重型颅脑创伤患者预后相关的独立危险因素,且对重型颅脑创伤患者伤情严重程度及预后有较好的预测价值。
文摘This review summarizes the current research advances and guideline updates in neurocritical care. For the therapy of ischemic stroke, the extended treatment time window for thrombectomy and the emergence of novel thrombolytic agents and strategies have brought greater hope for patient recovery. Minimally invasive hematoma evacuation and goal-directed bundled management have shown clinical benefits in treating cerebral hemorrhage. In the treatment of aneurysmal subarachnoid hemorrhage (aSAH), early lumbar drainage can reduce the risk of infarction. Decompressive craniectomy for severe traumatic brain injury has also obtained high-quality evidence support. However, multimodal brain monitoring strategies for patients with traumatic brain injury need further optimization. For patients with cardiac arrest, extracorporeal cardiopulmonary resuscitation can reduce in-hospital mortality and improve long-term neurological prognosis. For neurocritical care patients, abundant high-quality studies have emerged in areas including multimodal neuromonitoring, hemodynamic management, airway management and respiratory therapy, and antiepileptic treatment. In 2023, the guidelines for aSAH have been updated for the first time in the past decade, aiming to provide evidence-based practice recommendations for clinical care. Chinese expert consensuses have also been formulated to guide analgesia and sedation for neurocritical care patients and developed a set of medical quality indicators on neurocritical care, which will enhance standardization and homogenization improvement in neurocritical care quality.
