| 周 杰,芦 戬,李 波,任星光,王黄锁.颅内压、颅温及血清D-二聚体、白蛋白预测重型颅脑损伤患者术后短期预后的临床价值研究[J].,2022,(24):4772-4776 |
| 颅内压、颅温及血清D-二聚体、白蛋白预测重型颅脑损伤患者术后短期预后的临床价值研究 |
| Clinical Value Study of Intracranial Pressure, Cranial Temperature, Serum D-Dimer and Albumin in Predicting the Postoperative Short-Term Prognosis of Patients with Severe Traumatic Brain Injury |
| 投稿时间：2022-05-17 修订日期：2022-06-13 |
| DOI：10.13241/j.cnki.pmb.2022.24.034 |
| 中文关键词: 重型颅脑损伤 颅内压 颅温 D-二聚体 白蛋白 预后 |
| 英文关键词: Severe traumatic brain injury Intracranial pressure Cranial temperature D-dimer Albumin Prognosis |
| 基金项目:山西省卫生健康委科研项目（2021035）；太原钢铁（集团）有限公司科研项目（202202） |
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| 中文摘要: |
| 摘要 目的：探讨颅内压、颅温及血清D-二聚体（D-D）、白蛋白预测重型颅脑损伤（STBI）患者术后短期预后的临床价值。方法：选取2020年3月～2022年1月我院收治的124例STBI患者，对所有患者均开展颅脑手术治疗，术后3个月按照格拉斯哥结局量表（GOS）评分的差异分为预后不良组（GOS评分≤3分）43例以及预后良好组（GOS评分>3分）81例。记录术后颅内压、颅温及入院时血清D-D、白蛋白水平，采用多因素Logistic回归模型分析STBI患者术后短期预后不良的影响因素。采用受试者工作特征（ROC）曲线分析颅内压、颅温及血清D-D、白蛋白水平预测STBI患者术后短期预后不良的效能。结果：预后不良组术后颅内压及入院时血清D-D水平高于预后良好组，术后颅温以及入院时血清白蛋白水平低于预后良好组（均P＜0.05）。预后不良组年龄大于预后良好组，入院时格拉斯哥昏迷量表（GCS）评分低于预后良好组，多发性损伤、脑疝、高钠血症以及脑干损伤发生率高于预后良好组（均P＜0.05）。多因素Logistic回归分析结果显示：术后颅内压（较高）及入院时血清D-D水平（较高）为STBI患者术后短期预后不良的危险因素（P＜0.05），术后颅温（较高）以及入院时血清白蛋白水平（较高） 为STBI患者术后短期预后不良的保护因素 （P＜0.05）。ROC曲线分析结果显示：颅内压、颅温及血清D-D、白蛋白水平联合检测预测STBI患者术后短期预后不良的曲线下面积（AUC）、灵敏度、特异度均高于上述四项指标单独检测。结论：术后颅内压、颅温及入院时血清D-D、白蛋白水平均为STBI患者短期预后的影响因素，联合上述四指标预测STBI患者手术治疗后短期预后不良的价值较高。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the clinical value of intracranial pressure, intracranial temperature, serum D-dimer (D-D) and albumin in predicting the postoperative short-term prognosis of patients with severe traumatic brain injury (STBI). Methods: 124 patients with STBI who were admitted to our hospital from March 2020 to January 2022 were selected. All patients were treated with craniocerebral surgery. 3 months after operation, according to the difference of Glasgow Outcome Scale (GOS) score, they were divided into 43 cases in the poor prognosis group (GOS score ≤3 scores) and 81 cases in the good prognosis group (GOS score >3 scores). The postoperative intracranial pressure, intracranial temperature, serum D-D and albumin levels at admission were recorded. The influencing factors of poor short-term prognosis in patients with STBI were analyzed by multivariate Logistic regression model. The receiver operating characteristic (ROC) curve was used to analyze the efficacy of intracranial pressure, intracranial temperature, serum D-D and albumin levels in predicting the poor short-term prognosis of patients with STBI. Results: The postoperative intracranial pressure and serum D-D level at admission in the poor prognosis group were higher than those in the good prognosis group, and the postoperative intracranial temperature and serum albumin level at admission in the poor prognosis group were lower than those in the good prognosis group (all P＜0.05). The age in the poor prognosis group was older than that in the good prognosis group, the Glasgow Coma Scale (GCS) score at admission was lower than that in the good prognosis group, and the incidence of multiple injury, brain hernia, hypernatremia and brain stem injury was higher than that of the good prognosis group (all P＜0.05). Multivariate Logistic regression analysis showed that postoperative intracranial pressure (higher) and serum D-D level at admission (higher) were risk factors for poor short-term prognosis of patients with STBI (P＜0.05), and postoperative intracranial temperature (higher) and serum albumin level at admission (higher) were protective factors for poor short-term prognosis of patients with STBI (P＜0.05). ROC curve analysis showed that the area under the curve (AUC), sensitivity and specificity of the combined detection of intracranial pressure, intracranial temperature, serum D-D and albumin levels in predicting the poor postoperative short-term prognosis of patients with STBI were higher than those of the above four indicators. Conclusion: Postoperative intracranial pressure, intracranial temperature, serum D-D and albumin levels at admission are the influencing factors for the postoperative short-term prognosis of patients with STBI. The combination of the above four indicators is of high value in predicting the poor short-term prognosis of patients with STBI after surgical treatment. |
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