摘要
目的分析颈内静脉血氧饱和度(SjvO_(2))与颅内压联合监测对重症监护病房(ICU)脑出血术后患者预后的评估价值,为临床识别高危患者、判断患者预后提供更完善的理论依据。方法选取2017年6月至2020年6月重庆市第五人民医院重症医学科收治的50例脑出血术后患者为研究对象。按照SjvO_(2)将50例患者分为SjvO_(2)正常组(16例)、SjvO_(2)升高组(12例)和SjvO_(2)降低组(22例)。比较各组研究对象的SjvO_(2)、颅内压、格拉斯哥昏迷量表(GCS)评分、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及颈动静脉血氧含量差(AVDO_(2))、脑氧摄取率(CEO_(2))。分析SjvO_(2)与颅内压联合监测对预后不良事件的预测价值。结果术后相同时点SjvO_(2)正常组患者的颅内压水平及APACHEⅡ评分低于SjvO_(2)升高组和SjvO_(2)降低组、GCS评分高于SjvO_(2)升高组和SjvO_(2)降低组,差异均有统计学意义(均P<0.05)。术后相同时点SjvO_(2)降低组患者的AVDO_(2)和CEO_(2)水平均明显低于SjvO_(2)正常组;术后12、24 h及2 d SjvO_(2)升高组患者的AVDO_(2)和CEO_(2)水平高于SjvO_(2)正常组,随后迅速降低,差异均有统计学意义(均P<0.05)。SjvO_(2)与颅内压联合监测的曲线下面积、敏感度和特异度均明显高于SjvO_(2)和颅内压单独监测(0.830比0.773、0.692,75.2%比70.5%、65.4%,83.3%比75.3%、70.0%),差异均有统计学意义(均P<0.05)。结论SjvO_(2)与颅内压联合监测对ICU脑出血术后患者预后评估具有重要的参考价值。
Objective To analyze the prognostic value of internal jugular vein oxygen saturation(SjvO_(2))and intracranial pressure(ICP)combined monitoring in patients with intracerebral hemorrhage in intensive care unit(ICU)after operation,and to provide a more perfect theoretical basis for clinical identification of high-risk patients and judgment of patients′prognosis.Methods From June 2017 to June 2020,50 patients with intracerebral hemorrhage after operation treated in Department of Intensive Care Unit,Chongqing Fifth People′s Hospital were selected.According to SjvO_(2),50 patients were divided into SjvO_(2)normal group(16 cases),SjvO_(2)increased group(12 cases)and SjvO_(2)decreased group(22 cases).SjvO_(2),ICP,Glasgow coma scale(GCS)score,acute physiology and chronic health evaluation systemⅡ(APACHEⅡ)score,jugular arteriovenous oxygen content difference(AVDO_(2))and cerebral oxygen uptake rate(CEO_(2))were compared among the groups.The predictive value of SjvO_(2)and ICP combined monitoring in prognostic adverse events was analyzed.Results At the same time point after operation,the ICP level and APACHEⅡscore in SjvO_(2)normal group were lower than those in SjvO_(2)increased group and SjvO_(2)decreased group,and the GCS score in SjvO_(2)normal group was higher than that in SjvO_(2)increased group and SjvO_(2)decreased group(all P<0.05).The levels of AVDO_(2)and CEO_(2)in SjvO_(2)decreased group were significantly lower than those in SjvO_(2)normal group at the same time point after operation;the levels of AVDO_(2)and CEO_(2)in SjvO_(2)increased group were higher than those in SjvO_(2)normal group at 12,24 h and 2 d after operation,and then decreased rapidly(all P<0.05).The area under the curve,sensitivity and specificity of SjvO_(2)and ICP combined monitoring were significantly higher than those of SjvO_(2)and ICP alone(0.830 vs 0.773,0.692;75.2%vs 70.5%,65.4%;83.3%vs 75.3%,70.0%)(all P<0.05).Conclusion The SjvO_(2)and ICP combined monitoring has important reference value for the prognosis of patients with i
作者
邹帅
陈果
陈钇然
张婷
李灿
袁智慧
刘亚林
Zou Shuai;Chen Guo;Chen Yiran;Zhang Ting;Li Can;Yuan Zhihui;Liu Yalin(Intensive Care Unit,Chongqing Fifth People's Hospital,Chongqing 400062,China)
出处
《中国医药》
2021年第12期1808-1812,共5页
China Medicine
基金
重庆市卫生和计划生育委员会医学科研计划(2017MSXM154)。
关键词
脑出血
颈内静脉血氧饱和度
颅内压
预后评价
Intracerebral hemorrhage
Internal jugular vein oxygen saturation
Intracranial pressure
Prognosis evaluation
