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潘建英.动静脉氧差、呼吸指数在重症颅脑损伤短期预后评估中的价值分析[J].浙江中西医结合杂志,2021,31(6):
动静脉氧差、呼吸指数在重症颅脑损伤短期预后评估中的价值分析
The value of arteriovenous oxygen difference and respiratory index in the short-term prognosis of severe craniocerebral injury
投稿时间:2020-11-17  修订日期:2021-01-15
DOI:
中文关键词:  重症颅脑损伤  动静脉氧差  呼吸指数  预后评估
英文关键词:severe craniocerebral injury  arteriovenous oxygen difference  respiratory index  prognosis evaluation
基金项目:
作者单位E-mail
潘建英 浙江金华广福医院重症医学科 jianyingpan49@163.com 
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中文摘要:
      目的:检测重症颅脑损伤患者动静脉氧差(AVDO2)和呼吸指数(RI)的水平,并探究AVDO2和RI水平对重症颅脑损伤患者短期预后的评估价值。方法:选取2018年5月~2020年5月我院收治的颅脑损伤患者120例,轻中度颅脑损伤患者65例为轻中度组,重症颅脑损伤患者55例为重症组。使用全自动血气分析仪进行血气分析,并计算AVDO2和RI;通过研究对象工作特征曲线(ROC)评估AVDO2和RI水平在重症颅脑损伤中的诊断价值;分析患者预后不良情况与AVDO2和RI水平的关系;并采用Cox回归分析重症颅脑损伤患者短期预后的影响因素。结果:重症组AVDO2、RI水平均显著高于轻中度组(P<0.05)。ROC结果显示,AVDO2和RI诊断重症颅脑损伤的AUC分别为0.836、0.750,截断值分别为6.947mm Hg、1.344,此时对应敏感度分别为69.1%、61.8%,特异性分别为84.6%、81.5%。AVDO2高表达组患者预后不良发生率显著高于AVDO2低表达组(P<0.05);RI高表达组患者预后不良发生率显著高于RI低表达组(P<0.05)。Cox回归分析结果显示,AVDO2和RI高表达是影响重症颅脑损伤患者预后的独立危险因素(HR=2.389,95%CI为1.264~4.517;HR=3.069,95%CI为1.725~5.461;P均<0.05)。结论:AVDO2和RI在重症颅脑损伤患者中表达水平明显升高,两者影响重症颅脑损伤的发生及发展,且其表达水平与患者预后密切相关,提示AVDO2和RI可作为重症颅脑损伤患者短期预后评估的潜在指标。
英文摘要:
      Objective: To detect the levels of arteriovenous oxygen difference (AVDO2) and respiratory index (RI) in patients with severe brain injury, and to explore the value of AVDO2 and RI in the short-term prognosis of patients with severe brain injury. Methods: From May 2018 to May 2020, 120 patients with craniocerebral injury were selected, among them, 65 patients with mild to moderate craniocerebral injury were in the mild to moderate group, and 55 patients with severe craniocerebral injury were in the severe group. Blood gas analysis was carried out by using automatic multi parameter blood gas analyzer, and AVDO2 and RI were calculated; the diagnostic values of AVDO2 and RI in severe craniocerebral injury were evaluated by receiver operating characteristic curve (ROC); the relationships between the poor prognosis and the levels of AVDO2, RI were analyzed; and Cox regression was used to analyze the influencing factors of short-term prognosis in patients with severe craniocerebral injury. Results: The levels of AVDO2 and RI in severe group were significantly higher than those in mild and moderate group (P < 0.05). ROC results showed that the AUC of AVDO2 and RI was 0.836 and 0.750 respectively, and the cutoff value was 6.947 mm Hg and 1.344 respectively. At this time, the corresponding sensitivity was 69.1% and 61.8%, and the specificity was 84.6% and 81.5%, respectively. The incidence of poor prognosis in AVDO2 high expression group was significantly higher than that in AVDO2 low expression group (P < 0.05); and the incidence of poor prognosis in RI high expression group was significantly higher than that in RI low expression group (P < 0.05). Cox regression analysis showed that the high expressions of AVDO2 and RI were independent risk factors for the prognosis of patients with severe craniocerebral injury (HR = 2.389, 95% CI: 1.264-4.517; HR = 3.069, 95% CI: 1.725-5.461; P < 0.05). Conclusions: The expression levels of AVDO2 and RI in patients with severe craniocerebral injury are significantly increased, they affect the occurrence and development of severe craniocerebral injury, and their expression levels are closely related to the prognosis of patients, which is suggested that AVDO2 and RI can be used as potential indexes for short-term prognosis of patients with severe craniocerebral injury.
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