摘要
目的探讨联合监测颅内压力参数颅内压(Intracranial pressure,ICP)、平均压力反应指数(Pressure reactivity index,PRx)、平均颅内压波幅(Mean wave amplitude,MWA)对高血压脑出血去骨瓣减压术后患者预后的预测价值。方法选取2021年3月-2022年2月海安市人民医院神经外科收治的行去骨瓣减压术治疗的82例高血压脑出血患者为研究对象,随访3个月,记录血压脑出血去骨瓣减压术后患者预后情况,根据预后情况分为预后不良组和预后良好组。对比预后不良组和预后良好组临床资料及颅内压力参数ICP、PRx、MWA。采用多因素回归分析影响高血压脑出血去骨瓣减压术后预后的危险因素。制作受试者工作特征曲线(ROC),以曲线下面积(AUC)评价颅内压力参数ICP、PRx及MWA三者联合对高血压脑出血去骨瓣减压术患者预后的预测价值。结果高血压脑出血患者去骨瓣减压术后预后不良发生率为29.67%。预后不良组大骨窗占比、白细胞介素-6、超敏C反应蛋白、颅内压力参数ICP、PRx、MWA高于预后良好组(P<0.05)。多因素分析结果显示,颅内压力参数ICP(OR=3.031,95%CI:1.042~5.749)、PRx(OR=3.121,95%CI:1.387~6.143)、MWA(OR=3.340,95%CI:1.769~9.256)均为影响高血压脑出血患者去骨瓣减压术后预后的危险因素(P<0.05)。ROC曲线分析结果显示,ICP、PRx、MWA及三者联合对高血压脑出血患者去骨瓣减压术后预后的预测价值的灵敏度分别为70.83%(95%CI:48.75~86.56)、66.67%(95%CI:44.69~83.57)、70.52%(95%CI:48.24~86.89)、62.50%(95%CI:40.76~80.45),特异度分别为70.69%(95%CI:57.09~81.54)、74.14%(95%CI:60.71~84.35)、72.41%(95%CI:58.89~82.95)、98.28%(95%CI:89.54~99.91),AUC分别为0.715(95%CI:0.605~0.806)、0.707(95%CI:0.596~0.801)、0.709(95%CI:0.603~0.798)、0.894(95%CI:0.805~0.954)。结论ICP、PRx、MWA及三者联合对高血压脑出血患者去骨瓣减压术后的预后效能较高。
Objective To explorethe predictive value of combined monitoring of intracranial pressure parameters such as intracranial pressure(ICP),mean pressure response index(PRx)and mean wave amplitude(MWA)for the prognosis of the patients with hypertensive intracerebral hemorrhage after decompressive craniectomy.Methods 82 patients with hypertensive intracerebral hemorrhage who underwent decompressive craniectomy and were admitted to the neurosurgery department of the hospital from March 2021 to February 2022 were selected as the study subjects.The patients were followed up for 3 months and the prognosis of the patients with hypertensive intracerebral hemorrhage after decompressive craniectomy was recorded.Based on the prognosis,thepatients were divided into poor prognosis group and good prognosis group.Compare the clinical data and intracranial pressure parameters ICP,PRx and MWA between the poor prognosis group and the good prognosis group.Logistic multivariate regression analysis was used to investigate the risk factors affecting the prognosis of hypertensive intracerebral hemorrhage after decompressive craniectomy.Create a receiver operating characteristic curve(ROC)to evaluate the predictive value of intracranial pressure parameters ICP,PRx and MWA combined with the area under the curve(AUC)for the prognosis of thepatients with hypertensive intracerebral hemorrhage after decompressive craniectomy.Results The incidence of poor prognosis after decompressive craniectomy in patients with hypertensive intracerebral hemorrhage was 29.67%.The proportion of large bone window,interleukin-6,hypersensitive C-reactive protein,intracranial pressure parameters ICP,PRx and MWA in the poor prognosis group were higher than those in the good prognosis group(P<0.05).The results of multivariate analysis showed that intracranial pressure parameters ICP(OR=3.031,95%CI:1.042~5.749),PRx(OR=3.121,95%CI:1.387~6.143)and MWA(OR=3.340,95%CI:1.769~9.256)were all risk factors affecting the prognosis of hypertensive intracerebral hemorrhage patient
作者
丁锦荣
张寒
管义祥
DING Jinrong;ZHANG Han;GUAN Yixiang(Department of Neurosurgery,Haian People's Hospital,Nantong Jiangsu 226600,China)
出处
《新疆医科大学学报》
CAS
2023年第11期1457-1462,共6页
Journal of Xinjiang Medical University
基金
江苏省卫生健康委员会科研项目(Z2019033)。
关键词
颅内压
平均压力反应指数
平均颅内压波幅
高血压脑出血
去骨瓣减压术
intracranial pressure
mean stress response index
mean intracranial pressure amplitude
hypertensive intracerebral hemorrhage
decompressive craniectomy
