目的 研究美国国立卫生院脑卒中量表（NIHSS）评分、格拉斯哥昏迷评分（GCS）及指数记分法（BI）量表，预测脑梗死患者发病3个月后二便障碍预后的有效性。 方法 采取队列研究，登记2010年9月－2011年10月入院的脑梗死患者性别、年龄、婚姻、民族、职业，由脑卒中护士全面评定NIHSS评分、GCS评分、BI量表等指标。3个月后回访患者二便障碍恢复情况。 结果 分析显示NIHSS评分、GCS评分分值与脑梗死发病后3个月二便障碍恢复相关，BI量表评分分值与脑梗死发病后3个月二便障碍恢复无关。 结论 NIHSS评分、GCS评分分值可以预测脑梗死患者二便障碍恢复情况及预后情况，具有预测有效性。
Objective To observe the serumlevel of neuron-specific enolase( NSE) in patients with pulmonary encephalopathy and its changes after treatment with mechanical ventilation. Methods Twentyone patients with pulmonary encephalopathy were enrolled. Glasgow coma scale( GCS) , serumNSE level, and arterial blood gas were evaluated at three time-points: before mechanical ventilation, after 12 hours mechanical ventilation, and the moment of consciousness. Results 18 patients recovered consciousness, and 3 patients remained in persistent coma and died. GCS and arterial blood gas improved obviously after 12 hours mechanical ventilation. Meanwhile, the serumNSE concentration decreased significantly after 12 hours mechanical ventilation [ ( 24. 54 ±6. 65) μg/L] and at the moment of consciousness [ ( 14. 19 ±2. 91) μg/L] compared with before mechanical ventilation( P lt; 0. 05, P lt; 0. 01) . Conclusion Dynamic measurment of serumNSE may be a useful biomarker for assessing the severity of cerebral injury and predicting prognosis.
目的:探讨使用院前指数(Prehospital Index, PHI)及格拉斯哥昏迷评分(Glasgow Coma Score, GCS)两种创伤评分法对院前急救中急性酒精中毒合并外伤性颅内出血患者的评估价值。方法: 纳入68例院前急救中酒精中毒合并头外伤患者,院前均进行PHI及GCS两种创伤评分,随访至出院,以头部CT扫描及随访结果作为标准以判断患者是否伴有颅内出血。计算两种创伤评分的敏感度、特异度、阳性似然比、阴性似然比、阳性预测值、阴性预测值及Youden指数,并作出受试者工作特征曲线(ROC曲线),以正态离差值Z检验两种评分法ROC曲线下面积的差异。 结果: 院前指数以6分作为诊断界值,敏感度为94.7%,特异度为71.4%;格拉斯哥昏迷评分以9分作为诊断界值,敏感度为98.8%,特异度为30.6%,PHI及GCS的ROC曲线下面积分别是0.881和0.678,其差异有统计学意义。结论: 在对急性酒精中毒合并头外伤患者是否伴有颅内出血的院前评估中,院前指数较格拉斯哥昏迷评分更有价值。
ObjectiveTo explore the predictive factors for extubation in mechanically ventilated patients with moderate to severe traumatic brain injury (TBI). MethodsMechanically ventilated adult patients with moderate to severe brain injuries admitted to the People’s Hospital of Hunan province were selected between April 2020 and March 2022. The general data, neurological function and airway protective ability of the patients were collected. The patients were divided into successful extubation and failed extubation groups based on extubation outcomes. The differences in various indicators between the two groups were compared. Univariate and multivariate logistic regression analyses were conducted to determine the influencing factors for tracheal tube extubation in patients with moderate to severe TBI. Receiver operating characteristic (ROC) curves were plotted to analyze the predictive value of each indicator for extubation in TBI patients. ResultsA total of 263 patients with moderate to severe TBI were included in the analysis, with 183 patients in the successful extubation group and 80 patients in the failed extubation group. The successful extubation group had higher Glasgow coma scale (GCS) and cough peak flow (CPF) compared to the failed extubation group. The incidence of ventilator-associated pneumonia (VAP), duration of mechanical ventilation, length of ICU stay, and length of hospital stay were all lower in the successful extubation group. Univariate and multivariate logistic regression analyses showed that the predictive factors for tracheal tube extubation in patients with moderate to severe TBI were CPF and GCS at the time of extubation. Adjusting for confounding factors, every 1 L/min increase in CPF at the time of extubation reduced the risk of extubation failure by 2% [odds ratio (OR) = 0.98, 95% confidence interval (CI) 0.97 - 0.99], and every 1-point increase in GCS reduced the risk of extubation failure by 12% (OR = 0.88, 95%CI 0.79 - 0.98). ROC curve analysis showed that CPF, GCS, GCS eye, and GCS motor had predictive value for tracheal tube extubation in patients with moderate to severe TBI. When patients simultaneously met the criteria of GCS≥8 (GCS motor≥5, GCS eye≥3) and CPF ≥68.5 L/min, the diagnostic value for predicting successful extubation was highest, with an area under the ROC curve of 0.946 (95%CI 0.917 - 0.975), sensitivity of 0.850, and specificity of 0.907. ConclusionCPF ≥ 68.5 L/min and GCS ≥ 8 have clinical guiding value for successful extubation in mechanically ventilated patients with moderate to severe traumatic brain injury.