颅内压初始值对颅脑损伤后顽固性颅内压增高的预测价值

Predictive value of initial intracranial pressure to refractory intracranial hypertension in patients with traumatic brain injury

目的探讨颅内压（ICP）初始值（在手术室放置ICP监护探头后初次测得的ICP数值）对颅脑损伤（TBI）后顽固性颅内压增高（RICP，ICP持续维持在30mmHg以上超过15min，各种非手术治疗无效）的预测价值。方法对118例行ICP监测的TBI患者展开前瞻性观察研究，分析ICP初始值对RICP的预判价值。结果本组发生RICP43例，发生率为3．4％。Logistic回归分析显示ICP初始值是TBI患者发生RICP的独立危险因素（优势比为1．152；95％可信区间为1．078～1．232；P〈0．001）。受试者工作特征曲线分析结果显示初始ICP的最佳临界值为19．5mmHg，此时灵敏度为97．7％，特异度为64．7％；当初始ICP≥19．5mmHg时，RICP的发生率高达82．7％。结论TBI患者的ICP初始值≥19．5mmHg对发生RICP有很好的预测价值。

Objective To investigate the predictive value of the initial intracranial pressure （ICP） to the refractory intracranial hypertension in the patients with traumatic brain injury （TBI）. Methods ICP was monitored by Codman Express ICP monitor in 118 patients with TBI. The predictive values of initial ICP, which was determined immediately after placing the Codman Express ICP monitor, GCS and Marshall CT classification were analyzed by receiver operating characteristic （ROC） curve. Results ROC curve showed that the predictive value of the initial ICP to the refractory intracranial hypertension was significantly better than those of GCS and Marshall CT classification （P〈0.05）. The sensitivity of the initial ICP to the refractory intracranial hypertension was 97.7% and the specificity was 64.7% when the initial ICP was 19.5 mmHg. A multivariable logistic regression model showed that any 1 mmHg pressure increase in initial ICP led to 1.152-times higher odds of refractory intracranial hypertension （95% CI=1.078-1.232; P〈0.001）. Conclusion The initial ICP in patient with TBI is a better predictor of refractory intracranial hypertension compared to GCS and Marshall CT classification.