TCD在脓毒症患者脑循环监测中的应用及对其转归的预测价值

Clinical predictive value of TCD in monitoring cerebral circulation in sepsis patients

目的探讨经颅多普勒超声(TCD)在脓毒症患者脑循环及脑功能的动态评估价值及其对预后的预测价值。方法回顾性分析2017年1月至2018年6月入住本院98例脓毒症患者,按28 d预后分为生存组(56例)和死亡组(42例)。收集患者一般临床资料、急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)、谵妄评估量表(CAM-ICU)、入院第1天及第3天的TCD参数PSV、Vm、EDV、PI、RI,分析两组间不同时间TCD参数差异,并计算ROC曲线下面积(AUC)评估它们对脓毒症转归的预测价值。结果死亡组APACHEⅡ评分、脓毒症脑患者数明显高于生存组(P<0.05),无论是第1天还是第3天,两组间PSV、Vm、EDV差异无统计学意义,生存组的PI及RI低于死亡组(P<0.01),生存组第3天PI及RI较第1天明显下降(P<0.05),而死亡组第1、3天PI及RI未见明显变化。ROC生存曲线显示第1天PI、第3天PI、Day1PIDay3PI、第1天RI、第3天RI、Day1RI-Day3RI及APACHEⅡ预测脓毒症患者预后的AUC分别为0.657、0.835、0.730、0.707、0.826、0.705、0.815,P均<0.01,当第3天PI截断值为1.02时,灵敏度为85.7%、特异度为61.3%,第3天RI截断值为0.62时,灵敏度为78.6%、特异度为71.4%。结论TCD参数PI、RI对脓毒症患者脑循环及脑功能的动态评估存在一定价值。PI、RI在第1天和第3天及前后差值均对判断其预后有一定的价值且第3天PI、RI预测价值更大。

Objective To study the dynamic evaluation value of transcranial Doppler(TCD)in cerebral circulation and brain function of sepsis patients and its predictive value of the prognosis.Methods A retrospective analysis was performed on 98 sepsis patients admitted to our hospital from January 2017 to June 2018 who were divided into the survival group(56 cases)and death group(42 cases)according to the 28-day prognosis.The general clinical data of the patients,acute physiology and chronic health evaluation II(APACHE II),delirium assessment scale(CAM-ICU),and TCD parameters PSV,Vm,EDV,PI,RI on the first day and the third day of admission were collected,and the differences of TCD parameters at different time points were analyzed between the two groups,the area under the ROC curve(AUC)was calculated and evaluating their predictive value of sepsis outcome was evaluated.Results APACHEⅡscore and the number of patients with sepsis encephalopathy were significantly higher in the death group than those in the survival group(P<0.05).There were no significant differences in PSV,Vm and EDV between the two groups on the first day and the third day.The PI and RI of the survival group were significantly lower than those of the death group(P<0.01).In the survival group,PI and RI on the third day decreased significantly compared with those on the first day(P<0.05),while in the death group,PI and RI on the first day and the third day did not change significantly.ROC survival curves showed that Day1PI,Day3PI,Day1PI-Day3PI,Day1RI,Day3RI,Day1RI-Day3RI and APACHEⅡpredicted AUC of the prognosis of sepsis patients were 0.657,0.835,0.730,0.707,0.826,0.705,and 0.815(P<0.01).When PI cutoff value on the third day became 1.02,the sensitivity was 85.7%and the specificity was 61.3%.When RI cutoff value on the third day became 0.62,the sensitivity was 78.6%and the specificity was 71.4%.Conclusions TCD parameters,PI and RI,are of certain value in the dynamic evaluation of cerebral circulation and brain function in sepsis patients.PI and RI on the first day and the third day and the differences between them are all valuable in predicting the prognosis,and PI and RI on the third day have greater predictive value.