扰动系数对颅脑创伤后脑积水的预警作用

Predicting role of disturbance coefficient in post brain traumatic hydrocephalus

目的 探讨无创脑水肿监护仪的扰动系数对颅脑创伤后脑积水的预警作用。 方法 回顾性分析2016年12月至2018年1月南方医科大学南方医院神经外科收治的84例颅脑创伤患者的临床资料。其中,17例发生脑积水(脑积水组),67例未出现脑积水(对照组)。采用无创脑水肿监测技术对患者进行动态监护,比较两组患者的性别、年龄、入院格拉斯哥昏迷评分、扰动系数、颅脑CT结果、脑积水情况。 结果 出现脑积水的17例患者中,8例为正常压力脑积水,9例为高颅压脑积水。脑积水组的扰动系数下降中位数为35.2(25.7~48.1),对照组的扰动系数连续下降中位数为8.3(5.2~11.1),两组差异有统计学意义(P=0.008)。受试者工作特征曲线显示,扰动系数诊断脑积水的最佳截断点为18.0(灵敏度:92.5%,特异度:88.2%),其曲线下面积为0.94,即扰动系数下降≥18.0时,提示可能有脑积水的发生。 结论 无创脑水肿监护仪的扰动系数下降可预示脑积水的发生,且扰动系数下降程度越大,脑积水的发生概率越大。

Objective To evaluate the predicting value of disturbance coefficient (DC) of noninvasive brain edema monitoring in patients with secondary hydrocephalus after traumatic brain injury.Methods Non-invasive brain edema monitoring technology was used clinically to perform dynamic monitor of 84 patients with traumatic brain injury admitted to Department of Neurosurgery, Nanfang Hospital, Southern Medical University from December 2016 to January 2018. Among them, 17 had hydrocephalus (hydrocephalus group) and 67 did not (control group). The patient’s age, gender, Glasgow coma scale at admission, brain CT status, DC and hydrocephalus situation were compared between the 2 groups.Results Hydrocephalus occurred in 17 patients and 8 of them had normal pressure hydrocephalus. The median DC of patients with hydrocephalus was decreased by 35.2(25.7-48.1) and that of patients with no hydrocephalus was decreased by 8.3(5.2-11.1). The difference was statistically significant (P=0.008). The DC decrease of more than 18.0 (sensitivity: 92.5%;specificity: 88.2%) indicated the occurrence of hydrocephalus.Conclusions The decrease of DC in non-invasive brain edema monitoring could be used to predict the occurrence of early hydrocephalus. Higher continuous decrease of DC was related to greater probability of occurrence of intracranial hydrocephalus.