扰动系数预测不同年龄重型颅脑损伤患儿预后的临床价值

Clinical value of disturbance coefficient in predicting the prognosis of children with severe craniocerebral injury of different ages

摘要:

目的 探讨无创脑水肿动态监护仪扰动系数对不同年龄重型颅脑损伤患儿预后判定的临床价值。方法 选取2018年10月—2021年5月南京医科大学附属无锡儿童医院收治的颅脑损伤患儿131例作为研究对象。根据患儿年龄分为1～3岁组、> 3～5岁组、> 5～14岁组，分别有40例、44例和47例。根据颅脑损伤手术后6个月的预后，采用Logistic回归分析不同年龄患儿颅脑损伤预后的影响因素，采用受试者工作特征（ROC）曲线分析无创脑水肿动态监护仪扰动系数预测不同年龄患儿颅脑损伤预后的价值。结果 各组体重、GCS评分、颅内压、CK-MB、前白蛋白、白蛋白、扰动系数比较，差异有统计学意义（P <0.05）。共60例（46.51%）患儿预后不良。各组总预后不良率比较，差异无统计学意义（P >0.05）。多因素Logistic回归分析结果：乳酸［O^R=4.092（95% CI：1.684，9.945）、3.846（95% CI：1.582，9.347）、4.067（95% CI：1.674，9.885）］、GCS评分［O^R=3.364（95% CI：1.384，8.175）、3.313（95% CI：1.363，8.053）、4.200（95% CI：1.728，10.207）］、扰动系数［O^R=3.699（95% CI：1.522，8.989）、3.892（95% CI：1.602，9.460）、4.125（95% CI：1.697，10.024）］是影响1～3岁、> 3～5岁、> 5～14岁颅脑损伤患儿预后的独立因素（P <0.05）。ROC曲线结果显示：无创脑水肿动态监护仪扰动系数预测1～3岁组、> 3～5岁组、> 5～14岁组患儿敏感性分别为72.73%（95% CI：0.114，0.560）、73.68%（95% CI：0.102，0.455）、73.68%（95% CI：0.119，0.466），特异性分别为70.59%（95% CI：0.116，0.504）、76.00%（95% CI：0.101，0.514）、74.07%（95% CI：0.101，0.514）。结论 不同年龄重型颅脑损伤患儿预后不良风险高，无创脑水肿动态监护仪扰动系数预测1～3岁、> 3～5岁、> 5～14岁颅脑损伤患儿预后的效能良好。

Abstract:

Objective To explore the clinical value of the disturbance coefficient measured with non-invasive dynamic cerebral edema monitor in predicting the prognosis of children with severe craniocerebral injury of different ages.Methods The 131 children with craniocerebral injury admitted to the Wuxi Children's Hospital from October 2018 to May 2021 were selected and divided into 3 groups according to age, including 40 cases in the 1 to 3 years old group, 44 cases in the > 3 to 5 years old group, and 47 cases in the > 5 to 14 years old group. The prognosis at 6 months after the surgery for craniocerebral injury was observed. Logistic regression analysis was applied to determine the factors that affect the prognosis of children with craniocerebral injury of different ages, and receiver operating characteristic (ROC) curve analysis was performed to determine the value of the disturbance coefficient in predicting the prognosis of children with craniocerebral injury of different ages.Results The weight, Glasgow Coma Scale (GCS) score, intracranial pressure, creatine kinase-MB (CK-MB), prealbumin, albumin and disturbance coefficient were different among the groups (P < 0.05). Sixty cases (46.51%) had a poor prognosis, and the overall rate of poor prognosis was not different among the groups (χ² = 2.233, P = 0.327). Logistic multivariable regression analysis showed that lactic acid [O^R = 4.092 (95% CI: 1.684, 9.945), 3.846 (95% CI: 1.582, 9.347), 4.067 (95% CI: 1.674, 9.885) ], GCS score [O^R = 3.364 (95% CI: 1.384, 8.175), 3.313 (95% CI: 1.363, 8.053), 4.200 (95% CI: 1.728, 10.207) ], and disturbance coefficient [O^R = 3.699 (95% CI: 1.522, 8.989), 3.892 (95% CI: 1.602, 9.460), 4.125 (95% CI: 1.697, 10.024) ] were independent factor affecting the prognosis of children with craniocerebral injury in the 1 to 3 years old group, > 3 to 5 years old group and > 5 to 14 years old group (P < 0.05). ROC curve analysis showed that the sensitivity of disturbance coefficient for predicting the prognosis of children with craniocerebral injury was 72.73% (95% CI: 0.114, 0.560), 73.68% (95% CI: 0.102, 0.455) and 73.68% (95% CI: 0.119, 0.466), respectively for the 1 to 3 years old group, > 3 to 5 years old group and > 5 to 14 years old group, with the specificity being 70.59% (95% CI: 0.116, 0.504), 76.00% (95% CI: 0.101, 0.514) and 74.07% (95% CI: 0.101, 0.514), respectively.Conclusions The risk of poor prognosis is high in children with severe craniocerebral injury of different ages. The disturbance coefficient measured via non-invasive dynamic cerebral edema monitor is closely related to the prognosis, and effectively predicts the prognosis of children with craniocerebral injury at the age of 1 to 3 years, > 3 to 5 years, and > 5 to 14 years.