动静脉乳酸差值和动静脉氧差在诊断重型颅脑损伤合并脑梗死的意义

Significance of arteriojugular venous difference of lactate and arteriojugular venous difference of oxygen for the diagnosis of cerebral infarction in patients with severe traumatic brain injury

目的评估动静脉乳酸差值(AVDL)和动静脉氧差(AVDO2)在诊断重型颅脑损伤(severe traumatic brain injury,sTBI)病人中合并脑梗死的灵敏度、特异度、阳性似然比和阴性似然比。方法 45例重型颅脑损伤病人,每6h抽取股动脉和颈静脉球血样本,计算AVDL和AVDO2,分析这两项指标的临床诊断价值。结果采集358例血样本,通过计算得出AVDL和AVDO2的值,AVDL的灵敏度为91%,特异度为84%,阳性似然比为5.69,阴性似然比为0.095;AVDO2的灵敏度为81%,特异度为89%,阳性似然比为7.36,阴性似然比为0.212,平行试验的联合灵敏度为94%。结论 AVDL和AVDO2对于合并创伤性脑梗死的诊断价值较高,床边联合监测有助于早期发现重型颅脑损伤合并脑梗死的存在。

Objective The study aims to determine the sensitivity , specificity,positive likelihood rate and negative likelihood rate of arteriojugular venous difference of lactate （ AVDL） and arteriojugular venous difference of oxygen （ AVDO2 ） as an indicator of associated brain infarction in patients with severe traumatic brain injury （ sT-BI）.Methods Forty-five patients with acute and severe brain injuries were involved in this study .Blood samples were obtained through jugular bulb and femoral artery every six hours during the period of three days after injury . AVDL and AVDO2 were calculated for each patient .Results Totally 358 AVDL and AVDO2 determinations were collected.AVDL had a sensitivity of 91%, specificity of 84%,positive likelihood rate of 5.69 and negative likeli-hood rate of 0.095;AVDO2 had a sensitivity of 81%, specificity of 89%,positive likelihood rate of 7.36,and nega-tive likelihood rate of 0.212;the sensitivity was 94%with parallel tests .Conclusion Monitoring AVDL and AV-DO2 may be reliable to predict associated infarction damage in patients with sTBI .