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目的探讨联合经颅彩色多普勒(TCD)的搏动指数(PI)、血清神经元特异性烯醇化酶(NSE)和肿瘤坏死因子α(TNFˉα)、白介素6(ILˉ6)对脑复苏患者预后的预测价值。方法选取中山大学附属东华医院ICU/EICU科室2011年10月至2014年10月收治的60例心肺复苏成功的患者,根据患者意识转清或改善且生存时间>30 d者为生存组(n=26),生存时间<30 d为死亡组(n=34),评价PI、血清NSE、TNFˉα、ILˉ6含量与格拉斯哥昏迷量表(GCS)评分相关性并绘制ROC曲线评价上述指标预测预后的效果,比较联合指标与单一指标的优势。结果两组患者一般资料除急性心理与慢性健康状态评分系统II(APACHE II)评分外其他资料差异无统计学意义(P>0.05)。死亡组PI、血清NSE、ILˉ6显著高于生存组(P<0.05,P<0.01),GCS评分低于生存组,差异均有统计学意义。所有患者中PI、血清NSE、ILˉ6与GCS评分正相关(P<0.05,P<0.01)。四指标联合判定曲线下面积最大(0.817)。结论 PI、血清NSE和炎症介质与脑复苏患者的GCS评分有一定的相关性,联合指标评价患者预后具有较高的准确性,具有临床应用价值。
Objective To investigate the relationship between the prognosis of patients with cerebral resuscitation and the pulsatility index (PI), serum neuron specific enolase (NSE), tumor necrosis factor α (TNFα) and interleukin 6 (IL ˉ 6) in transcranial color Doppler Predicted value. Methods Sixty patients with successful cardiopulmonary resuscitation admitted to ICU / EICU Department of Tung Wah Hospital affiliated to Sun Yat-sen University from October 2011 to October 2014 were enrolled in this study. Patients who survived for more than 30 days were enrolled in the survival group (n = 26). The survival time was less than 30 days in the death group (n = 34). The correlations between PI, serum NSE, TNF-α, IL-6 and Glasgow Coma Scale (GCS) were evaluated and ROC curve was drawn to evaluate the prognosis , Compare the advantages of the joint indicator and single indicator. Results There was no significant difference between the two groups except for the APACHE II scores (P> 0.05). The death group PI, serum NSE, IL ˉ 6 were significantly higher than the survival group (P <0.05, P <0.01), GCS score was lower than the survival group, the difference was statistically significant. PI, serum NSE, IL ˉ 6 in all patients were positively correlated with GCS score (P <0.05, P <0.01). The area under the four indicators joint determination curve is the largest (0.817). Conclusions PI, serum NSE and inflammatory mediators have some correlation with GCS scores of patients with cerebral resuscitation. The combined index can evaluate the prognosis of patients with high accuracy and have clinical value.