西学东渐——新译“Glasgow coma scale”

西方的科学研究成果大多来源于英语的语言文化环境,把西方的科学研究成果介绍到中国,必须重视英语的语言文化环境和汉语的语言文化环境的不同,这样才能使国人准确、方便地应用西方的科学研究成果,西学东渐。格拉斯哥昏迷评分(Glasgow coma scale)被翻译、介绍到国内已有数十年,但汉语版的"Glasgow coma scale"多种多样,容易造成初学者和使用者的迷惑。本文复习有关"Glasgow coma scale"的原始英式英文文献、美式英语英文文献和以往的几个主要的汉语翻译版。结合英式英语、美式英语和汉语的语言文化特点,新译了"Glasgow coma scale",以方便医护人员使用。

Glasgow coma scale and APACHE-II scores affect the liver transplantation outcomes in patients with acute liver failure

BACKGROUND:The timing and selection of patients for liver transplantation in acute liver failure are great challenges.This study aimed to investigate the effect of Glasgow coma scale(GCS)and APACHE-II scores on liver transplantation outcomes in patients with acute liver failure.METHOD:A total of 25 patients with acute liver failure were retrospectively analyzed according to age,etiology,time to transplantation,coma scores,complications and mortality.RESULTS:Eighteen patients received transplants from live donors and 7 had cadaveric whole liver transplants.The mean duration of follow-up after liver transplantation was 39.86±40.23 months.Seven patients died within the perioperative period and the 1-,3-,5-year survival rates of the patients were72%,72%and 60%,respectively.The parameters evaluated for the perioperative deaths versus alive were as follows:the mean age of the patients was 33.71 vs 28 years,MELD score was 40 vs32.66,GCS was 5.57 vs 10.16,APACHE-II score was 23 vs 18.11,serum sodium level was 138.57 vs 138.44 mmol/L,mean waiting time before the operation was 12 vs 5.16 days.Low GCS,high APACHE-II score and longer waiting time before the operation(P【0.01)were found as statistically significant factors for perioperative mortality.CONCLUSION:Lower GCS and higher APACHE-II scores are related to poor outcomes in patients with acute liver failure after liver transplantation.

Neuroanatomical Basis of Glasgow Coma Scale—A Reappraisal

Glasgow coma scale is the most cited paper in neurosurgery. It has vast implications in the fields of neurology and neurosurgery. But lack of proper understanding in the neuro-anatomical basis of the score is the Achilles heel in proper utilization of the same. Herein we review the anatomical aspects behind each variable in the score. We also discuss common limitations of the score and highlight future directives to limit the same.

Outcome of Surgically Treated Acute Traumatic Epidural Hematomas Based on the Glasgow Coma Scale

This study was a retrospective analysis of outcome of surgically treated acute traumatic epidural hematomas based on the Glasgow coma scale. The series enrolled forty-six consecutive cases of acute traumatic epidural hematomas. The mean age of patients was 29.56 years and 63.04% of the patients were between 21 and 30 years of age. Forty-tree out of 46 (93.47%) of the patients were males. Road traffic crash was the main mode of injury. The severity of the traumatic brain injury was classified according to the Glasgow coma scale score at admission. The injury was mild or moderate in 35 (76.08%) cases and severe in 11. Eight patients (17.39%) presented with pupillary abnormalities. The computed tomography scanning of the head has objectivized the epidural hematoma in all patients and has shown a mass effect with midline shift in all but one case (45/46). The most frequent surgical procedure done was craniotomy. Six (13.04%) patients died (GOS 1), but 38 (82.60%) recovered fully (GOS 5) and two (04.34%) were disabled but independent (GOS 4). The Glasgow coma score at admission was very predictive for good or poor outcome, since all patients but one who died and all survivors who were disabled were comatose at admission (GCS ≤ 8).

Correlation between Glasgow Coma Scale with central venous pressure and near-infrared spectroscopy in patients with acquired brain injury in the intensive care unit of Adam Malik Hospital Medan

Background:Acquired brain injury(ABI)is caused by trauma or nontrauma to the brain after birth.Increased intracranial pressure in patients with traumatic or nontraumatic brain injury affects the cerebral perfusion pressure.After traumatic brain injury,there is an increase in air content in the brain and an increase in volume of blood flow to the brain,which can cause increased intracranial pressure,herniation of brain tissue,impaired cerebral perfusion,and brain damage.Most patients with traumatic brain injury die from uncontrolled increases in intracranial pressure.Near-infrared spectroscopy(NIRS)and central venous pressure(CVP)monitoring are also associated with cerebral perfusion.This study aimed to determine the relationship between the Glasgow Coma Scale(GCS)scores and CVP and NIRS values in patients with ABI.Methods:This prospective analytical study used a cross-sectional design to compareGCS scores with CVP and NIRS values in patients with traumatic and nontraumatic brain injury in the intensive care unit(ICU)of Haji Adam Malik Hospital Medan.GCS,CVP,and NIRS descriptive data in patients with brain injury were presented in terms of mean and standard deviation if the data were normally distributed,or median(interquartile range)values if the data were not normally distributed.The relationship between GCS scores and CVP and NIRS values was assessed using the Pearson correlation test if the data were normally distributed,or the Spearman test if the data were not normally distributed.Results:In this study,the mean GCS score and CVP values were 7.04±2.69 and 5.63±25.82 mmHg,respectively.The right tissue oxygen saturation(StO2)was 55.61%±18.72%,and the left StO2 was 57.57%±17.48%with normally distributed data.There was no correlation between GCS scores and CVP values(P=0.829),and no correlation between moderate GCS scores and right and left StO2(P=0.343;P=0.121);however,there was a significantly strong positive correlation between severe GCS scores and right and left StO2(P=0.028,r=0.656;P=0.005,r=0.777).Conclusion:There was no significant correlation between GCS scores and CVP values,and no correlation between moderate GCS scores and NIRS values;however,there was a significantly strong positive correlation between severe GCS scores and NIRS values in patients with ABI at the ICU of Haji Adam Malik Hospital Medan.

Evaluation of neuro-intensive care unit performance in China： predicting outcomes of Simplified Acute Physiology Score II or Glasgow Coma Scale

Background Severity scoring systems are useful tools for measuring the severity of the disease and its outcome. This pilot study was to verify and compare the prognostic performance of the Simplified Acute Physiology Score II （SAPS II） and Glasgow Coma Scale （GCS） in neuro-intensive care unit （N-ICU） patients. Methods A total of 1684 patients consecutively admitted to the N-ICU at Xuanwu Hospital between January 1, 2005 and December 31, 2011 were enrolled in this study. The data-base included admission data, at 24-, 48-, and 72-hour SAPS II and GCS. Repeated measure data analysis of variance, Logistic regression analysis, the Hosmer-Lemeshow goodness-of-fit statistic, and the area under the receiver operating characteristic were used to evaluate the performance. Results There was a significant difference between the SAPS II or GCS score at four time points （F=16.110, P=0.000 or F=8.108, P=0.000）. The SAPS II scores or GCS score at four time points interacted with the outcomes with significant difference （F=116.771, P=0.000 or F=65.316, P=0.000）. Calibration of the SAPS II or GCS score at each time point on all patients was good. The percentage of a risk estimate prediction corresponding to observed mortality was also good. The 72-hour score have the greatest consistency. Discriminations of the SAPS II or GCS score at each time were all satisfactory. The 72-hour score had the greatest discriminative power. The cut-off value was 33 （sensitivity of 85.2% and specificity of 74.3%） and 6 （sensitivity of 70.6% and specificity of 65.0%）. The SAPS II at each time point on all patients showed better calibration, consistency and discrimination than GCS. The binary Logistic regression analysis identified physiological variables, GCS, age, and disease category as significant independent risk factors of death. After the two variables including underlying disease and type of admission were excluded, we built the simplified SAPS II model. A correlation was suggested between the simplified SAPS II score at each time point and outcome, regardless of the diagnosis. Conclusions The GCS scoring system tends to be a little weaker in the predictive power than the SAPS II scoring system in this Chinese cohort of N-ICU patients. The advantage of SAPS II scoring system still exists that it dose not need to take into account the diagnosis or diseases categories, even in the special N-ICU. The simplified SAPS II scoring system is considered a new idea for the estimation of effectiveness.

Gender differences in adult traumatic brain injury according to the Glasgow coma scale:A multicenter descriptive study

Purpose:Patients’gender,which can be one of the most important determinants of traumatic brain injury(TBI)outcomes,is also likely to interact with many other outcome variables of TBI.This multicenter descriptive study investigated gender differences in epidemiological,clinical,treatment,mortality,and variable characteristics in adult TBI patients.Methods:The selection criteria were defined as patients who had been diagnosed with TBI and were admitted to the hospital between January 1,2016 and December 31,2018.A total of 4468 adult TBI patients were enrolled at eight University Hospitals.Based on the list of enrolled patients,the medical records of the patients were reviewed and they were registered online at each hospital.The registered patients were classified into three groups according to the Glasgow coma scale(GCS)score:mild(13-15),moderate(9-12),and severe(3-8),and the differences between men and women in each group were investigated.The risk factors of moderated and severe TBI compared to mild TBI were also investigated.Results:The study included 3075 men and 1393 women and the proportion of total males was 68.8%.Among all the TBI patients,there were significant differences between men and women in age,past history,and GCS score.While the mild and severe TBI groups showed significant differences in age,past history,and clinical symptoms,the moderate TBI group showed significant differences in age,past history,cause of justice,and diagnosis.Conclusion:To the best of our knowledge,this multicenter study is the first to focus on gender differences of adult patients with TBI in Korea.This study shows significant differences between men and women in many aspects of adult TBI.Therefore,gender differences should be strongly considered in TBI studies.

Glasgow Coma Scale, brain electric activity mapping and Glasgow Outcome Scale after hyperbaric oxygen treatment of severe brain injury

Objective: To study the effect of hyperbaric oxygen (HBO) treatment of severe brain injury. Methods: Fifty-five patients were divided into a treatment group (n=35 receiving HBO therapy) and a control group (n=20 receiving dehydrating, cortical steroid and antibiotic therapy) to observe the alteration of clinic GCS (Glasgow Coma Scale), brain electric activity mapping (BEAM), prognosis and GOS (Glasgow Outcome Scale) before and after hyperbaric oxygen treatment. Results: In the treatment group GCS,BEAM and GOS were improved obviously after 3 courses of treatment, GCS increased from 5.1 to 14.6 (P< 0.01- 0.001),the BEAM abnormal rate reduced from 94.3% to 38% (P< 0.01- 0.001),the GOS good-mild disability rate was 83.7%, and the middle-severe disability rate was 26.3% compared with the control group. There was a statistic significant difference between the two groups (P< 0.01- 0.001). Conclusions: Hyperbaric oxygen treatment could improve obviously GCS, BEAM and GOS of severe brain injury patients, and effectively reduce the mortality and morbidity. It is an effective method to treat severe brain injury.

Cerebral state index versus Glasgow coma scale as a predictor for in-hospital mortality in brain-injured patients

ObjectiveTo 在预言尖锐伤害大脑的 patients.MethodsIn 的医院分泌物地位上比较格拉斯哥昏迷规模(GCS ) 和服的州的索引(CSI ) 的价值没收到 sedatives， GCS 和 CSI 的 60 个伤害大脑的病人每天在开始的 10 &#xA0 期间被测量；住院的天。预示的截止的点的结果被 GCS 和关于承认的时间和第三天住院操作特征(巨鸟) 曲线的 CSI 使用接收装置计算。为两个索引的敏感，特性和另外的预兆的价值是 calculated.ResultsOf 60 个估计的病人，有的 14 个病人温和，中等的有的 13 个病人和 33 个病人有严重损害。在学习的功课期间， 17 个病人(28.3%) 处于他们的状况败坏了并且死。在在住院期间死亡了的病人的吝啬的 GCS 和 CSI 比从医院被解除的那些显著地低。GCS&#xA0； <&#xA0； 4.5 并且 CSI&#xA0； <&#xA0； 64.5 在创伤的大脑损害病人与更高的死亡风险在承认的时候被联系， GCS 比 CSI 更敏感在这些病人预言在里面医院死亡。为住院的第一天，在巨鸟曲线下面的区域为 GCS 是 0.947， 0.732 为在 ICU 承认的 CSI.ConclusionGCS 分数是在里面医院死亡的一个好预言者。GCS&#xA0； <&#xA0； 4.5 并且 CSI&#xA0； <&#xA0； 64.5 在创伤的大脑损害病人与更高的死亡风险在承认的时候被联系， GCS 是比在在这些病人预言死亡的 CSI 更敏感的。

缺血性脑卒中患者院内合并肺部感染的影响因素分析

目的分析缺血性脑卒中患者院内合并肺部感染的影响因素。方法回顾性分析2020年3月至2022年2月期间在南通市第三人民医院治疗的214例缺血性脑卒中患者病历资料。根据《中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南》分组,未合并肺部感染患者作为对照组(n=104),合并肺部感染患者作为观察组(n=110)。对患者性别、年龄、发病至入院时间、合并基础疾病、鼻饲饮食、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分、气管插管、呼吸机辅助通气等临床资料进行调查,分析缺血性脑卒中患者合并肺部感染的危险因素。结果观察组男56例,女54例,年龄(73.59±8.21)岁;对照组男45例,女59例,年龄(65.32±5.62)岁。单因素分析结果显示,观察组患者年龄、鼻饲饮食、NIHSS评分、GCS评分、是否气管插管、是否呼吸机辅助通气与对照组比较差异有统计学意义(t=8.511、χ^(2)=11.622、t=5.721、t=4.282、χ^(2)=6.868、χ^(2)=6.145,P均<0.05)。多因素Logistic回归分析结果显示,鼻饲饮食(OR=5.447,95%CI:2.477~11.976)、NIHSS评分(OR=8.339,95%CI:2.598~26.768)、GCS评分(OR=7.660,95%CI:3.369~17.413)、气管插管(OR=6.184,95%CI:2.447~15.628)、呼吸机辅助通气(OR=4.302,95%CI:1.830~10.110)是缺血性脑卒中患者合并肺部感染的独立危险因素。结论鼻饲饮食、病情严重程度、意识障碍、气管插管及呼吸机辅助通气是导致缺血性脑卒中患者发生肺部感染的独立危险因素,因此在患者入院时应及时评估,有针对性地实施预防措施。

分析高压氧联合神经外科手术治疗重型颅脑损伤的临床效果

目的 探讨高压氧联合神经外科手术治疗重型颅脑损伤的临床效果。方法 选取2020年2月—2022年11月青岛市黄岛区人民医院收治的66例重型颅脑损伤患者为研究对象,按照投掷硬币法分为参照组(33例,采用的治疗方法为神经外科手术)和研究组(33例,采用的治疗方法为参照组基础上的高压氧治疗)。比较两组患者的治疗总有效率、功能独立自主量表(Functional Indepence Measure,FIM)评分、Glasgow昏迷评分量表(Glasgow Coma Scale,GCS)评分、并发症(持续高热、上消化道出血、肺部感染、肾损伤)总发生率。结果研究组治疗总有效率(96.97%)高于参照组(75.76%),差异有统计学意义(χ^(2)=6.304,P<0.05)。治疗前,两组FIM评分、GCS评分比较,差异无统计学意义(P均>0.05);治疗后,研究组FIM评分、GCS评分均高于参照组,差异有统计学意义(P均<0.05)。两组并发症(持续高热、上消化道出血、肺部感染、肾损伤)总发生率比较,差异无统计学意义(P>0.05)。结论 高压氧+神经外科手术治疗方法的有效应用,对于重型颅脑损伤患者疗效提升、昏迷状态改善以及生活自理能力提升方面,可以获得明显效果,可促进重型颅脑损伤患者的良好预后。

长程脑电图和Glasgow昏迷量表评分对重症脑功能损伤患者预后的预测价值

目的探讨长程EEG和Glasgow昏迷量表评分(GCS)对重症脑功能损伤患者预后的预测价值。方法对75例神经系统重症脑功能损伤患者行长程EEG监测和GCS评分,并随访90 d时患者的预后情况。分别计算长程EEG、GCS及长程EEG联合GCS对预后预测的灵敏度、特异度、准确度,并进行比较。结果长程EEG中重度异常患者的预后不良率显著高于轻度异常患者(χ~2=31.375,P<0.01)。GCS低评分患者的预后不良率显著高于高评分患者(χ~2=16.58,P<0.001)。长程EEG轻度异常且GCS评分高者预后不良率显著低于EEG中重度异常且GCS评分低者(χ~2=29.726,P<0.001)。长程EEG对患者预后预测的灵敏度、特异度和准确度均高于GCS评分。长程EEG联合GCS评分对患者预后预测的特异度和准确度与长程EEG相仿,而灵敏度显著升高。结论长程EEG和GCS对重症脑功能损伤患者的预后评估均有一定的预测价值,二者联合评估效果更好。

Glasgow昏迷量表在高血压性脑出血急救策略选择中的作用

目的探讨入院时Glasgow昏迷量表(GCS)评分对高血压性脑出血患者急救策略的影响。方法共286例高血压性脑出血患者中186例接受手术治疗,包括GCS评分5~8分94例、9~11分71例和12~14分21例,分别予血肿清除术联合去骨瓣减压术(63例,22.03%)、单纯血肿清除术(21例,7.34%)和血肿钻孔引流术或脑室外引流术(102例,35.66%);100例接受保守治疗,包括GCS评分5~8分25例、9~11分27例、12~14分25例和15分23例。随访3~6个月,采用Glasgow预后分级(GOS)评价疗效。结果 GCS评分5~8分组失访6例(5.04%),GOS分级1级14例(11.76%)、2级21例(17.65%)、3级39例(32.77%)、4级22例(18.49%)、5级17例(14.29%);GCS评分9~11分组失访2例(2.04%),GOS分级1级6例(6.12%)、2级2例(2.04%)、3级6例(6.12%)、4级48例(48.98%)、5级34例(34.69%);GCS评分12~14组GOS分级4级15例(32.61%)、5级31例(67.39%);GCS评分15分组GOS分级4级1例(4.35%)、5级22例(95.65%),组间差异具有统计学意义(χ~2=142.966,P=0.000)。结论高血压性脑出血患者入院时GCS评分与其预后呈正相关,GCS评分越高、GOS分级越高。

Glasgow评分在急性创伤患者低体温发生中的预测作用

目的:了解急性创伤患者低体温的发生情况,分析Glasgow评分(Glasgow Coma Scale,GCS)在低体温发生中的应用价值。方法:回顾性收集2014年3月至2018年12月在佛山市中医院治疗的急性创伤患者资料,应用SPSS 22.0软件对获取的数据进行统计分析。结果:共287例急性创伤患者,其中105例(36.6%)发生低体温;不同创伤程度患者的低体温发生率差异具有统计学意义(F=57.580,P<0.05);低体温患者的GCS评分和无低体温患者的GCS评分差异具有统计学意义(P<0.05);GCS评分与低体温的发生呈负相关,相关系数为−0.490(P<0.05);受试者工作特征曲线(receiver operating characteristics,ROC)分析显示,其曲线下面积为0.785(P<0.05),并且在截断值为7分时,敏感性系数为0.575,特异性系数为0.867,约登指数最大,为0.552。结论:GCS评分对急性创伤患者发生低体温具有中等以上的预测效能,临床医护人员可据此及早实施保暖措施,避免低体温造成的不良后果。

外周血FDP/Fib值联合GCS评分对创伤性脑损伤患者预后的预测价值

目的:探讨外周血纤维蛋白降解产物/纤维蛋白原(FDP/Fib)比值联合格拉斯哥昏迷评分(GCS)对创伤性脑损伤(TBI)患者预后的预测价值。方法:选取80例中重度TBI患者为研究对象,根据28 d预后分为死亡组(n=26)与存活组(n=54)。比较两组患者临床特征[年龄、性别、创伤机制、血压、心率和呼吸频率、GCS评分、创伤严重程度评分(ISS)]和实验室指标[血白细胞计数、血小板计数、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、D-二聚体(D-D)、纤维蛋白原(Fib)、纤维蛋白降解产物(FDP)、FDP/Fib值];Pearson相关系数分析外周血FDP/Fib值与ISS、GCS评分的相关性;多元Logistic回归分析中重度TBI患者28 d死亡的独立预测因子;采用受试者工作特征(ROC)曲线评估外周血FDP/Fib值、GCS评分及二者联合对预后的预测价值。结果:死亡组GCS评分、APTT和Fib低于存活组(P<0.001);ISS评分、PT、D-D、FDP、FDP/Fib值高于存活组(P<0.05)。Pearson相关系数分析显示,外周血FDP/Fib值与ISS评分正相关(P<0.05);与GCS评分负相关(P<0.05)。多元Logistic回归分析显示,GCS评分(OR=1.344)和FDP/Fib值(OR=1.145)是中重度TBI患者28 d死亡的独立预测因子(P<0.05)。ROC曲线分析显示,外周血FDP/Fib值、GCS评分及二者联合预测TBI预后的曲线下面积(AUC)分别为0.854、0.890、0.948,二者联合预测价值最高(P<0.001)。结论:外周血FDP/Fib值与TBI患者病情程度相关,联合GCS评分对TBI患者的预后有较好的预测价值。

创伤性颅脑损伤患者血清NGF、NF-L水平与脑损伤程度和预后的关系

目的 通过前瞻性研究分析血清神经生长因子(NGF)和神经丝蛋白轻链(NF-L)水平与患者创伤性颅脑损伤(TBI)严重程度和预后之间的关系及其预测价值。方法 收集132例TBI患者和132例普通外伤患者分别作为观察组和对照组;观察组患者根据格拉斯哥昏迷(GCS)评分分为轻症、中症和重症3个亚组;观察组患者在随访6个月时按格拉斯哥预后评分(GOS)评分分为良好组和不良组;采用酶联免疫吸附试验(ELISA)检测所有患者入院后血清NGF、NF-L水平;通过对比观察组和对照组,明确颅脑损伤和血清NGF和NF-L水平之间的关系;通过对比观察组不同亚组之间的差异,明确血清NGF、NF-L水平与颅脑损伤程度和预后之间的关系;通过相关关系、受试者工作特征(ROC)曲线和多因素Logistic回归分析,明确血清NGF、NF-L水平对TBI的预测价值。结果 相比于对照组,观察组血清NGF、NF-L水平显著升高,GCS评分显著降低(P<0.01);此外,观察组中,轻症、中症和重症亚组血清NGF、NF-L水平逐渐升高(P<0.01);血清NGF、NF-L水平预测轻症颅脑损伤的曲线下面积(AUC)分别为0.924(95%CI:0.889~0.986)和0.991(95%CI:0.982~1.000),截断值为12.5 ng/mL和66.5 pg/mL,预测中症TBI的AUC分别为0.776(95%CI:0.686~0.862)和0.837(95%CI:0.763~0.911),预测重症TBI的AUC分别为0.950(95%CI:0.900~0.987)和0.988(95%CI:0.971~1.000),截断值分别为14.5 ng/mL和157.0 pg/mL;Spearman相关分析显示血清NGF、NF-L水平与TBI患者预后GOS评分呈负相关(P<0.01),其预测TBI患者预后的AUC分别为0.858(95%CI:0.776~0.932)和0.909(95%CI:0.824~0.978),截断值分别为13.5 ng/mL和71.5 pg/mL;Logistic回归分析结果显示血清NGF、NF-L水平是影响TBI患者预后的危险因素(P<0.05)。结论 TBI患者的血清NGF、NF-L水平显著升高,且可为临床早期评估损伤严重程度提供参考。此外,血清NGF、NF-L水平升高与患者不良预后有关,是预测预后的良好生物学指标。

多指标联合对严重创伤后脓毒症患者预后的预测价值

目的探讨影响严重创伤后脓毒症患者预后的相关危险因素,构建Nomogram预测模型,评估模型的临床应用价值。方法选取2017年1月至2023年5月收住联勤保障部队第九二○医院急诊重症监护病房(ICU)的严重创伤后脓毒症患者100例进行回顾性分析。根据临床结局将患者分为死亡组(n=42)和存活组(n=58),收集两组受伤机制、受伤类别、感染部位、住院时间、住ICU时间、机械通气时间、入ICU时急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、格拉斯哥昏迷评分(GCS)及序贯器官衰竭评估(SOFA)评分,第7天降钙素原(PCT)、累积液体平衡量(CFB)和中性粒细胞与淋巴细胞比值(NLR),比较两组患者组间差异,对有统计学意义指标进行单因素和多因素Logistic回归分析确立影响严重创伤后脓毒症患者死亡的独立危险因素,构建Nomogram预测模型,应用R软件绘制列线图,采用受试者工作特征(ROC)曲线和校准曲线对模型预测效能进行验证,采用决策曲线分析(DCA)评估模型的临床净收益。结果入ICU第7天PCT(95%CI 2.067~10.432,OR=4.644,P<0.001)和第7天CFB(95%CI 1.529~6.079,OR=3.048,P=0.002)是严重创伤后脓毒症患者死亡的独立危险因素,GCS评分(95%CI 0.054~0.459,OR=0.158,P=0.001)是与预后相关的独立危险因素。根据多因素Logistic回归分析结果建立Nomogram模型,经验证,预测模型的一致性指数(C-index)为0.902,校准曲线与拟合曲线反应好,AUC为0.902,敏感度85.7%,特异度87.9%;DCA评估模型的临床应用价值,最大净获益阈值概率区间为12.0%~100.0%,模型具有高净获益值。结论入ICU第7天PCT和第7天累积液体平衡量是严重创伤后脓毒症患者死亡的独立危险因素,GCS评分是与预后相关的独立危险因素,在此基础构建的Nomogram模型具有良好的预测效能和临床应用价值。

脑出血术后多重耐药感染风险的诺模图预测模型的构建与验证

目的探讨脑出血术后多重耐药感染的风险因素并构建诺模图预测模型。方法收集2020年7月—2023年7月本院收治的241例脑出血手术患者的临床资料,并分为感染组和非感染组。采用Logistic回归模型分析脑出血患者术后发生多重耐药感染的独立影响因素,并构建诺模图预测模型。采用一致性指数(C-index)、受试者工作特征(ROC)曲线及校准曲线评价诺模图的预测效能。结果本研究共纳入241例脑出血患者,术后发生多重耐药感染56例(23.24%)。感染组术前格拉斯哥昏迷量表(GCS)评分、术前呕吐、术前抗菌药物治疗、留置胃管、气管切开、气管插管比率高于非感染组,差异有统计学意义(P<0.05)。Logistic回归分析显示,术前GCS评分≤8分、术前呕吐、术前抗菌药物治疗、留置胃管、气管切开、气管插管均是脑出血患者术后发生多重耐药感染的独立危险因素(OR>1,P<0.05);术前GCS评分、术前呕吐、术前抗菌药物治疗、气管切开、气管插管的曲线下面积(AUC)值均>0.700,说明上述指标对于脑出血患者术后发生多重耐药感染具有较好的预测价值。基于以上影响因素建立诺模图风险模型,校准曲线的C-index值为0.798,说明诺模图模型具备较好的区分度;ROC曲线中建模组和验证组的AUC值分别为0.798和0.722,说明诺模图模型具有良好的预测能效。结论基于脑出血患者术后发生多重耐药感染的独立危险因素构建的诺模图预测模型能较好地预测脑出血患者术后发生多重耐药感染的概率。

血清胆碱酯酶联合GCS评分对重型闭合性颅脑损伤预后的评估价值

目的探讨入院时血清胆碱酯酶(cholinesterase,ChE)联合格拉斯哥昏迷评分(Glasgow coma scale,GCS)对重型闭合性颅脑损伤病人28d院内预后的预测价值。方法回顾性分析87例重型闭合性颅脑损伤病例资料,根据28d院内的生存情况分为存活组(n=64)与死亡组(n=23)。比较两组病人基线资料、GCS评分、ChE以及急性生理学和慢性健康评估Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分。采用多因素Logistic回归,分析重型闭合性颅脑损伤病人28d院内预后的影响因素。绘制受试者工作特征曲线(receiver operating characteristic,ROC),确定最佳临界值,分析ChE联合GCS评分评估重型闭合性颅脑损伤病人28d院内预后的价值。结果存活组ChE水平、GCS评分及血红蛋白均显著高于死亡组,而血糖、D-二聚体、凝血酶原时间及APACHEⅡ评分显著低于死亡组(均P<0.05)。多因素Logistic回归分析显示:ChE、GCS评分及APACHEⅡ评分是重型闭合性颅脑损伤病人28d院内出现死亡的影响因素(均P<0.05)。ROC曲线分析显示:ChE联合GCS评分曲线下面积大于两者单独预测时的曲线下面积。结论入院时ChE、GCS评分均对重型闭合性颅脑损伤病人预后具有预测价值,两者联合价值更高。