动静脉氧差、血乳酸差值及呼吸指数在重型颅脑损伤合并脑梗死中的诊断价值

The diagnostic value of arterial and venous oxygen difference blood lactic acid difference and respiratory index in severe craniocerebral injury complicated with cerebral infarction

目的 探讨动静脉氧差、血乳酸差值及呼吸指数对中重型颅脑损伤合并脑梗死的早期诊断价值。方法采用前瞻性研究方案,根据住院期间是否发生外伤性脑梗死将225例中重型颅脑损伤患者分为脑梗死组37例和非脑梗死组188例。详细统计患者入院时疾病评估资料;分别于入院时、入院第3d、第10d、出院时抽取颈内静脉血和股动脉血,采用全自动多参数血气分析仪侧定动脉-静脉氧含量差(AVDO2)、血乳酸差值(AVDL)及呼吸指数;并记录患者ICU入住时间、28d死亡率和出院时神经功能缺损(NIHSS)评分。结果 入院时,脑梗死组AVDO2和呼吸指数高于非脑梗死组,AVDL低于非脑梗死组;入院后,两组AVDO2和呼吸指数均有降低,血乳酸差值均有升高;出院时,脑梗死组AVDL仍低于非脑梗死组,呼吸指数仍高于非脑梗死组;差异有统计学意义(P<0.05)。ROC曲线分析患者入院时和入院3d的AVDO2、AVDL和呼吸指数对脑梗死及28d死亡均有诊断价值,且入院时AVDO2和呼吸指数诊断脑梗死的AUC最高,分别为0.941和0.920;入院3dAVDO2和呼吸指数诊断28d死亡率的AUC最高,分别为0.850和0.865。结论 动静脉氧差、血乳酸差值及呼吸指数对中重型颅脑损伤患者发生外伤性脑梗死以及28d内死亡均有较好的诊断价值。

Objective to investigate the early diagnostic value of arterial and venous oxygen difference,blood lactic acid difference and respiratory index in patients with severe craniocerebral injury complicated with cerebral infarction.Methods aprospective study was conducted to divide 225 patients with moderate to severe craniocerebral injury into 37 patients in the cerebral infarction group and 188 patients in the non-cerebral infarction group.Detailed statistics of disease assessment data at admission;The blood of carotid vein and femoral artery was extracted on admission,3d,10d and discharge,respectively.Automatic multi-parameter blood gas analyzer was used to determine the difference in artery-vein oxygen content(AVDO2),blood lactic acid difference(AVDL)and respiratory index.ICU stay,28d mortality,and neurologic impairment(NIHSS)score at discharge were recorded.Results on admission,AVDO2 and respiratory index of cerebral infarction group were higher than that of non-cerebral infarction group,and AVDL was lower than that of non-cerebral infarction group.After admission,AVDO2 and respiratory index were decreased in both groups,and the difference of blood lactic acid was increased.At discharge,AVDL of cerebral infarction group was still lower than that of non-cerebral infarction group,and respiratory index was still higher than that of non-cerebral infarction group.The difference was statistically significant(P<0.05).ROC curve analysis of AVDO2,AVDL and respiratory index at admission and 3 days after admission has diagnostic value for cerebral infarction and death on 28 days,and the AUC of AVDO2 and respiratory index in diagnosis of cerebral infarction at admission is the highest,0.941 and 0.920,respectively.The AUC of 28d mortality diagnosed by 3d AVDO2 and respiratory index was the highest,which were 0.850 and 0.865,respectively.Conclusion the difference of arterial and venous oxygen,blood lactic acid and respiratory index have good diagnostic value for traumatic cerebral infarction and death within 28 days in patients with severe craniocerebral injury.