目的探讨脑血管痉挛指数(Lindegaard index,LR)预测早期脓毒症相关性脑病(sepsis-associated encephalopathy,SAE)的临床价值。方法选取2021年11月至2022年3月首都医科大学附属北京朝阳医院急诊监护室脓毒症患者,收集入院患者24 h内一...目的探讨脑血管痉挛指数(Lindegaard index,LR)预测早期脓毒症相关性脑病(sepsis-associated encephalopathy,SAE)的临床价值。方法选取2021年11月至2022年3月首都医科大学附属北京朝阳医院急诊监护室脓毒症患者,收集入院患者24 h内一般临床资料,以重症加强护理病房谵妄评估量表(confusion assessment method for the intensive care unit,CAM-ICU)及格拉斯哥昏迷评分(Glasgow coma score,GCS)作为临床诊断SAE金标准,在确诊脓毒症后3 d内出现CAM-ICU阳性或持续性GCS≤14诊断为SAE。对比分析SAE组与非SAE组入院第1天及第3天大脑中动脉(middle cerebral artery,MCA)收缩期峰值流速(systolic velocity,Vs)、舒张末期流速(diastolic velocity,Vd)、平均流速(mean velocity,Vm)、搏动指数(pulsatility index,PI)、阻力指数(resistant index,RI)、LR等超声血流动力学参数,采用Logistic回归分析脓毒症早期发生SAE的危险因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线。结果37例脓毒症患者纳入本研究,SAE组17例,非SAE组20例。SAE组入院24 h内急性生理与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、GCS评分、血乳酸、脑血管痉挛发生率及28 d病死率均明显高于非SAE组(P<0.05)。第1天(D1)SAE组VsD1、VdD1、VmD1及LRD1均明显高于非SAE组(P<0.05)。第3天(D3)SAE组与非SAE组各项血流动力学指标差异均无统计学意义。SAE组组内第3天VsD3、VdD3、VmD3及LRD3均较第1天明显下降(P<0.05);SAE组ΔLR(LRD1-LRD3)显著高于非SAE组(P<0.05)。Logistic回归分析显示入院24 h APACHEⅡ评分、LRD1及ΔLR是SAE的危险因素,ROC分析显示APACHEⅡ评分、LRD1、ΔLR及APACHEⅡ评分联合ΔLR预测早期SAE的曲线下面积(area under the curve,AUC)分别是0.94、0.86、0.77、0.96,P均<0.05。LRD1诊断SAE的界值为2.6,灵敏度为76.47%,特异度为95.00%。APACHEⅡ联合ΔLR对SAE的诊断效能最好(AUC=0.96,95%CI:0.85~0.99,P<0.05),灵敏度为88.24%,特异度为95.00%。结论脓毒症患者入院24 h APACHEⅡ评分、LRD1及ΔLR均可预测早期SAE的发生,APACHEⅡ与ΔLR联合可进一步提高对早期SAE的预测效能。床旁超声动态评估脓毒症患者脑血流及LR对早期SAE的诊断具有较高临床价值。展开更多
Non-invasive Doppler ultrasonographic study of cerebral arteries [transcranial Doppler(TCD)] has been extensively applied on both outpatient and inpatient settings. It is performed placing a low-frequency(≤ 2 MHz) tr...Non-invasive Doppler ultrasonographic study of cerebral arteries [transcranial Doppler(TCD)] has been extensively applied on both outpatient and inpatient settings. It is performed placing a low-frequency(≤ 2 MHz) transducer on the scalp of the patient over specific acoustic windows, in order to visualize the intracranial arterial vessels and to evaluate the cerebral blood flow velocity and its alteration in many different conditions. Nowadays the most widespread indication for TCD in outpatient setting is the research of right to left shunting, responsable of so called "paradoxical embolism", most often due to patency of foramen ovale which is responsable of the majority of cryptogenic strokes occuring in patients younger than 55 years old. TCD also allows to classify the grade of severity of such shunts using the so called "microembolic signal grading score". In addition TCD has found many useful applications in neurocritical care practice. It is useful on both adults and children for day-to-day bedside assessment of critical conditions including vasospasm in subarachnoidal haemorrhage(caused by aneurysm rupture or traumatic injury), traumatic brain injury, brain stem death. It is used also to evaluate cerebral hemodynamic changes after stroke. It also allows to investigate cerebral pressure autoregulation and for the clinical evaluation of cerebral autoregulatory reserve.展开更多
文摘目的探讨脑血管痉挛指数(Lindegaard index,LR)预测早期脓毒症相关性脑病(sepsis-associated encephalopathy,SAE)的临床价值。方法选取2021年11月至2022年3月首都医科大学附属北京朝阳医院急诊监护室脓毒症患者,收集入院患者24 h内一般临床资料,以重症加强护理病房谵妄评估量表(confusion assessment method for the intensive care unit,CAM-ICU)及格拉斯哥昏迷评分(Glasgow coma score,GCS)作为临床诊断SAE金标准,在确诊脓毒症后3 d内出现CAM-ICU阳性或持续性GCS≤14诊断为SAE。对比分析SAE组与非SAE组入院第1天及第3天大脑中动脉(middle cerebral artery,MCA)收缩期峰值流速(systolic velocity,Vs)、舒张末期流速(diastolic velocity,Vd)、平均流速(mean velocity,Vm)、搏动指数(pulsatility index,PI)、阻力指数(resistant index,RI)、LR等超声血流动力学参数,采用Logistic回归分析脓毒症早期发生SAE的危险因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线。结果37例脓毒症患者纳入本研究,SAE组17例,非SAE组20例。SAE组入院24 h内急性生理与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、GCS评分、血乳酸、脑血管痉挛发生率及28 d病死率均明显高于非SAE组(P<0.05)。第1天(D1)SAE组VsD1、VdD1、VmD1及LRD1均明显高于非SAE组(P<0.05)。第3天(D3)SAE组与非SAE组各项血流动力学指标差异均无统计学意义。SAE组组内第3天VsD3、VdD3、VmD3及LRD3均较第1天明显下降(P<0.05);SAE组ΔLR(LRD1-LRD3)显著高于非SAE组(P<0.05)。Logistic回归分析显示入院24 h APACHEⅡ评分、LRD1及ΔLR是SAE的危险因素,ROC分析显示APACHEⅡ评分、LRD1、ΔLR及APACHEⅡ评分联合ΔLR预测早期SAE的曲线下面积(area under the curve,AUC)分别是0.94、0.86、0.77、0.96,P均<0.05。LRD1诊断SAE的界值为2.6,灵敏度为76.47%,特异度为95.00%。APACHEⅡ联合ΔLR对SAE的诊断效能最好(AUC=0.96,95%CI:0.85~0.99,P<0.05),灵敏度为88.24%,特异度为95.00%。结论脓毒症患者入院24 h APACHEⅡ评分、LRD1及ΔLR均可预测早期SAE的发生,APACHEⅡ与ΔLR联合可进一步提高对早期SAE的预测效能。床旁超声动态评估脓毒症患者脑血流及LR对早期SAE的诊断具有较高临床价值。
文摘Non-invasive Doppler ultrasonographic study of cerebral arteries [transcranial Doppler(TCD)] has been extensively applied on both outpatient and inpatient settings. It is performed placing a low-frequency(≤ 2 MHz) transducer on the scalp of the patient over specific acoustic windows, in order to visualize the intracranial arterial vessels and to evaluate the cerebral blood flow velocity and its alteration in many different conditions. Nowadays the most widespread indication for TCD in outpatient setting is the research of right to left shunting, responsable of so called "paradoxical embolism", most often due to patency of foramen ovale which is responsable of the majority of cryptogenic strokes occuring in patients younger than 55 years old. TCD also allows to classify the grade of severity of such shunts using the so called "microembolic signal grading score". In addition TCD has found many useful applications in neurocritical care practice. It is useful on both adults and children for day-to-day bedside assessment of critical conditions including vasospasm in subarachnoidal haemorrhage(caused by aneurysm rupture or traumatic injury), traumatic brain injury, brain stem death. It is used also to evaluate cerebral hemodynamic changes after stroke. It also allows to investigate cerebral pressure autoregulation and for the clinical evaluation of cerebral autoregulatory reserve.
