中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2011年
6期
352-354
,共3页
李海玲%缪文丽%任红贤%林慧艳%莎宁
李海玲%繆文麗%任紅賢%林慧豔%莎寧
리해령%무문려%임홍현%림혜염%사저
脑电双频指数%脑损伤,急性%预后
腦電雙頻指數%腦損傷,急性%預後
뇌전쌍빈지수%뇌손상,급성%예후
Bispectral index%Acute brain injury%Prognosis
目的 探讨持续脑电双频指数(BIS)监测对急性脑损伤患者预后的评估作用.方法 采用回顾性研究方法,选择2009年3月至2010年7月重症监护病房(ICU)急性脑损伤昏迷患者61例,根据预后将患者分为生存组(25例)和死亡组(36例).于入ICU 3 d内或停用镇静剂24 h后持续12 h监测BIS,取其均值(BISmean)、记录BIS最大值(BISmax)和最小值(BISmin).记算患者急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分、存活概率(PS)、格拉斯哥昏迷评分(GCS),并于监测当日取静脉血检测S100蛋白、神经元特异性烯醇化酶(NSE)水平;分析BISmean与GCS评分、$100蛋白、NSE水平的相关性.结果 ①两组患者性别、年龄、机械通气时间无明显差异.死亡组APACHE Ⅱ评分(分)明显高于生存组(27.36±5.99比23.28±6.69),PS明显低于生存组(0.31±0.17比0.49±0.19),住ICU时间(d)明显短于生存组(6.33±4.48比27.88±54.46),P<0.05或P<0.01.②死亡组BISmean、BISmax、BISmin、GCS均明显低于生存组(BISmean:35.45±28.31比55.91±17.53,BISmax:51.92±34.24比74.84±16.58,BISmin:22.39±24.83比39.68±15.72,GCS评分(分):3.64±1.19比5.60±2.22],P<0.05或P<0.01;血清S100蛋白、NSE水平明显高于生存组[S100蛋白(μg/L):7.54±10.49比1.18±1.57,NSE(μg/L):120.74±109.01比49.83±54.94],均P<0.01.③双变量相关分析显示,BISmean与GCS评分呈显著正相关(r=0.379,P=0.003),与S100蛋白、NSE水平呈显著负相关(r1=-0.418,P1=0.001;r2=-0.290,P2=0.023).结论 BIS监测具有无创、直观、易于操作、可连续监测的特点,可以作为判断急性脑损伤患者预后的早期客观指标.
目的 探討持續腦電雙頻指數(BIS)鑑測對急性腦損傷患者預後的評估作用.方法 採用迴顧性研究方法,選擇2009年3月至2010年7月重癥鑑護病房(ICU)急性腦損傷昏迷患者61例,根據預後將患者分為生存組(25例)和死亡組(36例).于入ICU 3 d內或停用鎮靜劑24 h後持續12 h鑑測BIS,取其均值(BISmean)、記錄BIS最大值(BISmax)和最小值(BISmin).記算患者急性生理學與慢性健康狀況評分繫統Ⅱ(APACHE Ⅱ)評分、存活概率(PS)、格拉斯哥昏迷評分(GCS),併于鑑測噹日取靜脈血檢測S100蛋白、神經元特異性烯醇化酶(NSE)水平;分析BISmean與GCS評分、$100蛋白、NSE水平的相關性.結果 ①兩組患者性彆、年齡、機械通氣時間無明顯差異.死亡組APACHE Ⅱ評分(分)明顯高于生存組(27.36±5.99比23.28±6.69),PS明顯低于生存組(0.31±0.17比0.49±0.19),住ICU時間(d)明顯短于生存組(6.33±4.48比27.88±54.46),P<0.05或P<0.01.②死亡組BISmean、BISmax、BISmin、GCS均明顯低于生存組(BISmean:35.45±28.31比55.91±17.53,BISmax:51.92±34.24比74.84±16.58,BISmin:22.39±24.83比39.68±15.72,GCS評分(分):3.64±1.19比5.60±2.22],P<0.05或P<0.01;血清S100蛋白、NSE水平明顯高于生存組[S100蛋白(μg/L):7.54±10.49比1.18±1.57,NSE(μg/L):120.74±109.01比49.83±54.94],均P<0.01.③雙變量相關分析顯示,BISmean與GCS評分呈顯著正相關(r=0.379,P=0.003),與S100蛋白、NSE水平呈顯著負相關(r1=-0.418,P1=0.001;r2=-0.290,P2=0.023).結論 BIS鑑測具有無創、直觀、易于操作、可連續鑑測的特點,可以作為判斷急性腦損傷患者預後的早期客觀指標.
목적 탐토지속뇌전쌍빈지수(BIS)감측대급성뇌손상환자예후적평고작용.방법 채용회고성연구방법,선택2009년3월지2010년7월중증감호병방(ICU)급성뇌손상혼미환자61례,근거예후장환자분위생존조(25례)화사망조(36례).우입ICU 3 d내혹정용진정제24 h후지속12 h감측BIS,취기균치(BISmean)、기록BIS최대치(BISmax)화최소치(BISmin).기산환자급성생이학여만성건강상황평분계통Ⅱ(APACHE Ⅱ)평분、존활개솔(PS)、격랍사가혼미평분(GCS),병우감측당일취정맥혈검측S100단백、신경원특이성희순화매(NSE)수평;분석BISmean여GCS평분、$100단백、NSE수평적상관성.결과 ①량조환자성별、년령、궤계통기시간무명현차이.사망조APACHE Ⅱ평분(분)명현고우생존조(27.36±5.99비23.28±6.69),PS명현저우생존조(0.31±0.17비0.49±0.19),주ICU시간(d)명현단우생존조(6.33±4.48비27.88±54.46),P<0.05혹P<0.01.②사망조BISmean、BISmax、BISmin、GCS균명현저우생존조(BISmean:35.45±28.31비55.91±17.53,BISmax:51.92±34.24비74.84±16.58,BISmin:22.39±24.83비39.68±15.72,GCS평분(분):3.64±1.19비5.60±2.22],P<0.05혹P<0.01;혈청S100단백、NSE수평명현고우생존조[S100단백(μg/L):7.54±10.49비1.18±1.57,NSE(μg/L):120.74±109.01비49.83±54.94],균P<0.01.③쌍변량상관분석현시,BISmean여GCS평분정현저정상관(r=0.379,P=0.003),여S100단백、NSE수평정현저부상관(r1=-0.418,P1=0.001;r2=-0.290,P2=0.023).결론 BIS감측구유무창、직관、역우조작、가련속감측적특점,가이작위판단급성뇌손상환자예후적조기객관지표.
Objective To discuss the effect of continuous monitoring of bispectral index(BIS)on the prognosis of patients with acute brain injury.Methods A retrospective study was carried out,61 patients with acute brain injury admitted to the intensive care unit (ICU) from March 2009 to July 201 0 were divided into survival group (n=25) and death group (n=36).The BIS was continuously monitored for 12 hours within the first 3 days or 24 hours after stoppage of sedative after admission to ICU.The mean value of BIS (BISmean),the maximal value of BIS(BISmax),and the minimal value of BIS(BISmin)were evaluated.At the same time,the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,probability of survival (PS) and Glasgow coma score (GCS) were evaluated.The values of serum S100 protein and neuron-specific enolase (NSE) were determined.The relationship between BISmean and GCS,S100 protein and NSE were respectively analyzed.Results ①There was no significant difference in the sex,age,or duration of mechanical ventilation between two groups.APACHE Ⅱ score in death group was significantly higher than the survival group (27.36±5.99 vs.23.28±6.69),PS was significantly lower than the survival group(0.31±0.17 vs.0.49±0.19),and length of stay in ICU (days) was significantly lower than that of the survival group(6.33±4.48 vs.27.88±54.46),P<0.05 or P<0.01.②BISmean,BISmax,BISmin,GCS in death group were significantly lower than those in the survival group (BISmean:35.45±28.31 vs.55.91±17.53,BISmax:51.92±34.24 vs.74.84±1 6.58,BISmin:22.39±24.83 vs.39.68±15.72,GCS score:3.64±1.19 vs.5.60±2.22),P<0.05 or P<0.01,while serum S100 protein and NSE levels were significantly higher than the survival group(S100 protein(μg/L):7.54±10.49 vs.1.18±1.57,NSE (μg/L):120.74±109.01 vs.49.83±54.94],both P<0.01.③By bivariate analysis,BISmean was positively correlated with GCS(r=0.379,P=0.003),whereas it was found to be negatively correlated with S100 protein and NSE levels(r1=-0.418,P1=0.001;r2=-0.290,P2=0.023).Conclusion BIS monitoring can be applied as an early objective indicator to evaluate the prognosis of the acute brain injured patients with the characteristics of being noninvasive,intuitive,easy-to-manipulate,and non-stop monitoring.
