摘要
目的评估外伤性脑损伤（TBI）患儿脑血管二氧化碳反应性（CO：R）的变化及CO2R受损对患儿预后的影响。方法选取在我院神经外科重症监护室（ICU）住院治疗的128例TBI患儿，在患儿入院治疗48h内测量患儿的相对CO2R值，之后每24h测量1次。采用儿科格拉斯哥转归量表（GOS—EPeds）评估患儿短期预后，采用ROC曲线确定预测有利或不利预后的CO2R截断值。分析影响患儿CO2R受损的相关因素，并以这些因素（年龄、性别、GOS—EPeds评分）进行分组，比较不同分组患儿CO2R值的变化，采用Logistic回归模型评估患儿预后的预测因素。结果入院48h，有55（43．0％）例患儿CO2R异常。最佳截断值为20．58％（AUC=0．816，P=0．025，敏感度0．75，特异度0．73，约登指数0．48）。截至复苏后第4天，大部分CO2R受损患儿的CO2R[47（85．5％）]恢复正常。与CO2R正常患儿比较，CO2R受损患儿年龄显著降低[（1．32±0．38）岁VS．（8．97±1．71）岁，t=37．029，P〈0．001]，男性患儿比例显著提高（74．5％VS．54．8％，X^2=5．266，P=0．022），GOS—EPeds评分5—8分患儿比例显著提高（45．5％V8．20．5％，X^2=9．056，P=0．003）。入院第1～7天，低龄（0—2岁）、中龄（3—5岁）与大龄（〉5岁）组CO2R值比较差异有统计学意义（F=139．85，P=0．038）。与低龄组（t=6．689，P=0．008）、大龄组（t=5．906，P=0．014）比较，中龄组患儿CO2R显著提高。与大龄组（t=16．227，P〈0．001）比较，低龄组患儿CO2R显著降低。男性患儿组CO2R显著低于女性患儿组（t=5．708，P=0．019）。男性患儿初始平均CO2R较低。患儿复苏后CO2R监测第6天，这种关系发生逆转。与预后较好患儿组比较，预后较差患儿组CO2R显著降低，差异有统计学意义（t=4．572，P=0．046）。Logistic回归模型分析显示，CO2R均值较低是TBI患儿预后差的独立危险因素（OR=1．188，95％CI1．045—1．340，P=0．016）。结论TBI患儿发生C02R受损比例较高，CO2R受损对TBI患儿预后不利，年龄与性别对TBI患儿CO2R变化影响显著，CO2R均值较低与TBI患儿预后差相关。
Objective To evaluate the changes of cerebrovascular carbon dioxide reactivity （CO2R） in children with traumatic brain injury （TBI） and the influence of CO2R damage on the prognosis of children. Methods 128 children with TBI who were hospitalized in the department of neurosurgery intensive care unit （ICU） were selected. The relative CO：R values of the children were measured at admission to 48 h, and measured every 24 h. The pediatric Glasgow Outcome Scale （ GOS - E Peds） was used to evaluatethe short - term outcome of the children. A ROC curve was used to determine CO2R cut - off values for favorable or unfavorable prognosis. The related factors that affect CO2R damage in children were analyzed. The children were grouped according to these factors （age, gender, and GOS - E Peds score）. The COE R values of children in different groups were compared, and Logistic regression model was used to evaluate predictors of prognosis. Results There were 55 （43%） children with abnormal CO2R in admission to 48 h. The optimal cut - off value was 20.58% （ AUC = 0. 816, P =0.025, the sensitivity was 0.75, specificity was 0.73, Youden index was 0.48）. By the 4 th day after the recovery, the COER of most of the CO2R damaged children[47（85.5% ） ]had returned to normal. Compared with CO2R normal children, the age of CO2R damaged children was significantly lower [（1.32 ±0.38） years old, vs. （8.97 ±1.71） years old, t =37.029, P〈0.001]. The proportion of male children was significantly increased （74.5%, vs. 54.8%, X^2 = 5. 266, P = 0. 022）. The proportion of children with GOS - E Peds score 5 - 8 was significantly higher （45.5% vs. 20.5%, X^2 = 9. 056, P = 0. 003 ）. Admission Day 1 to Day 7, there was significant difference in CO2 R between the younger（0 -2 years old）, the middle age（3 N 5 years old） and the older group（ 〉 5 years old）. Compared with the younger group （ t = 6.689, P = 0. 008 ） and the older group （ t = 5. 906, P = 0. 014）, the CO2R valuein the middle age group was significantly higher. Compared with the older group （t = 16.227, P 〈0.001 ）, the CO2R value was significantly lower in the younger group. The COaR of male children was significantly lower than that of female children （t = 5. 708, P = 0.019）. The male children had a lower average mean CO2 R value. At the CO2 R monitoring Day 6 after the recovery of children, this comparison reversed. Compared with the better prognosis group, the COER of the children with poor prognosis was significantly lower （ t = 4. 572, P = 0. 046 ）. Logistic regression analysis showed that the lower mean CO2R was an independent risk factor for poor prognosis in TBI children （ OR = 1. 188, 95% CI 1. 045 - 1. 340, P = 0. 016 ）. Conclusion TBI children COER damage occurs in a higher proportion. COER damage is unfavorable to the prognosis of TBI children. The age and gender have significant effect on CO2R changes in children with TBI, and the lower COER is correlated with the prognosis of TBI children.
出处
《中国急救医学》
CAS
CSCD
北大核心
2017年第11期1005-1010,共6页
Chinese Journal of Critical Care Medicine
