摘要
目的探讨无创脑水肿动态监测对神经危重症患者脑水肿病情和预后的评估价值,为临床及时判断脑水肿的严重程度、指导治疗提供理论依据。方法选取开滦总医院神经重症加强治疗病房（NICU）住院治疗且存在意识障碍的神经危重症患者127例,应用无创脑水肿监护仪床旁动态监测并记录患者双侧大脑半球脑电阻抗扰动系数,同时记录患者GCS评分、NIHSS评分,并于发病1个月时记录患者mRS评分,分析各类患者不同监测时间点大脑半球扰动系数的波动情况及双侧半球间的差异,并探讨影响患者预后的相关危险因素。结果重症单侧颈内动脉系统脑梗死及脑出血患者患侧扰动系数在发病14 d内均随着时间延长呈明显上升趋势（F=3.45,P=0.0249;F=3.75,P=0.0225）;其患侧与健侧扰动系数比较均无统计学差异（P〉0.05）,但重症单侧颈内动脉系统脑梗死患者发病2~7 d及7~14 d监测组患侧扰动系数较健侧增高〉0.3。以患者预后为因变量的多元Logistic回归分析结果显示重症脑梗死患者、GCS评分越低、患侧扰动系数和NIHSS评分越高,以及既往脑出血患者预后越差。结论无创脑水肿动态监测可相对准确地反映神经危重症患者脑水肿的轻重程度,并可为脑水肿的临床治疗及其预后的判定提供一定的指导。
Objective to evaluate the condition and prognosis in patients with neurological intensive by noninvasive dynamic monitoring of cerebral edema,and provide theoretical basis for judging severity of brain edema and guiding treatment in clinical timely. Methods Selection of 127 cases with disturbance of consciousness in neurological intensive care unit（ NICU） of Kailuan General Hospital,monitoring and recording agitating coefficient of bilateral cerebral hemisphere brain by non-invasive brain edema monitor beside the bed dynamicly,at the same time recording the patients,GCS score,NIHSS score and mRS score which could assess the patients prognosis during the onset of 1 month. All patients classified according to different causes,analyzing monitoring cerebral hemisphere volatility of agitating coefficient and the difference of bilateral hemispheres in all kinds of patients at different time points,and associating risk factors that affected prognosis of patients. Results Agitating coefficient of patients with cerebral infarction and cerebral hemorrhage of severe unilateral internal carotid artery system were significant rise（ F = 3. 45,P = 0. 0249; F = 3. 75,P = 0. 0225） within 14 days of the extended over time,and there were no statistical difference in agitating coefficient between bilateral cerebral hemisphere brain（ P〈0. 05）,but in severe cerebral infarction patients with unilateral internal carotid artery system agitating coefficient of the onset of 2 to 7 days and 7 to 14 days monitoring group was higher than that of the contralateral 〉0. 3. Variable multiple Logistic regression analysis which made patient prognosis as the dependent showed that patients with severe cerebral infarction,the lower the GCS score,the higher the NIHSS score,the higher the risk of contralateral agitating coefficient,as well as worse prognosis of patients with cerebral hemorrhage. Conclusion Noninvasive brain edema dynamic monitoring can be relatively accurately reflect the degree of cerebral edema in patients with neurolo
出处
《临床神经病学杂志》
CAS
北大核心
2016年第5期355-358,共4页
Journal of Clinical Neurology
基金
2016年河北省重点研发计划项目(16277713D)
关键词
神经危重症
无创脑水肿动态监测
病情判断
预后
neurological intensive
non-invasive dynamic monitoring of cerebral edema
condition judgment
prognosis
