经颅多普勒、Rotterdam CT评分联合颅内压检测在重症颅脑损伤患者预后判断中的应用

【摘要】目的探讨经颅多普勒、鹿特丹（Rotterdam）CT评分联合颅内压检测在重症颅脑损伤（TBI）患者预后判断中的应用价值。方法回顾性分析80例重症TBI患者的临床资料，根据术后3个月格拉斯哥预后量表评分（GOS）将患者分为预后良好组和预后不良组，分析Rotterdam CT评分与术后3个月病死率与预后不良率的关系，并比较术后1、3、7 d时搏动指数（PI）和颅内压（ICP）变化情况，利用Spearman相关性及受试者工作特征曲线（ROC）分析Rotterdam CT评分、PI、ICP与预后的相关性及预后判断中的价值。结果80例患者中有32例（40.0%）预后良好，48例（60.0%）预后不良；预后良好组患者入院后1、3、7 d时PI、ICP均低于预后不良组（均P<0.05）；Rotterdam CT评分4～6分之间患者术后3个月病死率与预后不良率之间比较有统计学差异（均P<0.05）；GOS评分与PI、ICP、Rotterdam CT评分均呈负相关（r=-0.682、-0.658、-0.309，P<0.01）；PI、ICP、Rotterdam CT评分单独及联合判断预后的ROC曲线下面积（AUC）分别为0.850、0.857、0.658、0.927，联合判断的AUC均高于PI、ICP、Rotterdam CT评分单独判断的AUC（P<0.05）。结论经颅多普勒、Rotterdam CT评分以及颅内压检测均能够为重症TBI患者提供重要预后信息，并且联合检测能够提高预测患者病死率及长期预后的效能。

Abstract: Objective To explore the application value of transcranial doppler and Rotterdam CT score combined with intracranial pressure(ICP) detection in determining prognosis of patients with severe traumatic brain injury(TBI). Methods The clinical data of 80 patients with severe TBI were analyzed retrospectively. The patients were divided into good prognosis group and poor prognosis group according to Glasgow outcome score(GOS) 3 months after operation. The relationship between Rotterdam CT score and mortality and poor prognosis 3 months after operation was analyzed, and the changes of pulsatility index(PI) and ICP at 1, 3 and 7 days after operation were compared, Spearman correlation and receiver operating characteristic curve(ROC) were used to analyze the correlation between Rotterdam CT score, PI, ICP and prognosis and its value in prognosis judgment. Results Of the 80 patients, there were 32(40.0%) cases with good prognosis, and 48(60.0%) with poor prognosis. At 1d, 3d and 7d after admission, PI and ICP in good prognosis group were lower than those in poor prognosis group(P<0.05). There were significant differences in mortality and poor prognosis rate at 3 months after surgery among patients with Rotterdam CT score with 4-6 points(P<0.05). GOS score was negatively correlated with PI, ICP and Rotterdam CT score(r=-0.682, -0.658, -0.309, P<0.01). Area under the ROC curve(AUC) of PI, ICP, Rotterdam CT score and their combination for determining prognosis were 0.850, 0.857, 0.658 and 0.927, AUC of combination judgement was higher than that of single index(P<0.05). Conclusions TCD, Rotterdam CT score and ICP detection can provide important prognosis information for patients with severe TBI. Their combination detection can improve efficiency of predicting mortality and long-term prognosis.