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 pre...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.展开更多
目的:比较改良版Munro围术期成人压疮风险评估量表与斯卡特触发点对手术患者发生压力性损伤的预测效度及评估的一致性。方法:采用病例对照研究方法,选取2017年至2019年在重庆医科大学附属第二医院进行手术的患者270名,收集一般资料和手...目的:比较改良版Munro围术期成人压疮风险评估量表与斯卡特触发点对手术患者发生压力性损伤的预测效度及评估的一致性。方法:采用病例对照研究方法,选取2017年至2019年在重庆医科大学附属第二医院进行手术的患者270名,收集一般资料和手术资料,将确诊已发生手术获得性压力性损伤的45名患者作为病例组,根据手术科室采用1∶5配对方法,选取同期进行手术但未发生手术获得性压力性损伤的225名患者作为对照组,使用改良版Munro量表与斯卡特触发点分别评分并记录,计算受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC),以及量表的约登指数、灵敏度、特异度、阳性预测值、阴性预测值、κ值。结果:病例组和对照组Munro量表评分分别为(29.870±3.279)分、(26.460±3.381)分,斯卡特触发点评分分别为(2.361±0.900)分、(1.650±0.989)分。Munro量表的AUC=0.764(95%CI=0.692~0.873),最佳诊断界值、灵敏度、特异度、阳性预测值、阴性预测值分别为28.500、0.667、0.720、0.248、0.934;斯卡特触发点AUC=0.691(95%CI=0.610~0.772),最佳诊断界值、灵敏度、特异度、阳性预测值、阴性预测值分别为1.500、0.822、0.502、0.289、0.923。两种评估量表的κ值为0.497,差异有统计学意义(P<0.05)。结论:改良版Munro量表与斯卡特触发点均能有效评估患者发生手术获得性压力性损伤的风险,存在中度一致性。从临床实际工作出发,术前采用改良版斯卡特触发点对手术患者压力性损伤风险进行评估具有可操作性,值得推广。展开更多
文摘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.
文摘目的:比较改良版Munro围术期成人压疮风险评估量表与斯卡特触发点对手术患者发生压力性损伤的预测效度及评估的一致性。方法:采用病例对照研究方法,选取2017年至2019年在重庆医科大学附属第二医院进行手术的患者270名,收集一般资料和手术资料,将确诊已发生手术获得性压力性损伤的45名患者作为病例组,根据手术科室采用1∶5配对方法,选取同期进行手术但未发生手术获得性压力性损伤的225名患者作为对照组,使用改良版Munro量表与斯卡特触发点分别评分并记录,计算受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC),以及量表的约登指数、灵敏度、特异度、阳性预测值、阴性预测值、κ值。结果:病例组和对照组Munro量表评分分别为(29.870±3.279)分、(26.460±3.381)分,斯卡特触发点评分分别为(2.361±0.900)分、(1.650±0.989)分。Munro量表的AUC=0.764(95%CI=0.692~0.873),最佳诊断界值、灵敏度、特异度、阳性预测值、阴性预测值分别为28.500、0.667、0.720、0.248、0.934;斯卡特触发点AUC=0.691(95%CI=0.610~0.772),最佳诊断界值、灵敏度、特异度、阳性预测值、阴性预测值分别为1.500、0.822、0.502、0.289、0.923。两种评估量表的κ值为0.497,差异有统计学意义(P<0.05)。结论:改良版Munro量表与斯卡特触发点均能有效评估患者发生手术获得性压力性损伤的风险,存在中度一致性。从临床实际工作出发,术前采用改良版斯卡特触发点对手术患者压力性损伤风险进行评估具有可操作性,值得推广。
