Kuo Jinn-Rung, Yeh Tsong-Chih, Sung Kuan-Chin, Wang Che-Chuan, Chen Chi-Wen, Chio Chung-Ching
Department of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan 710, Taiwan.
J Clin Neurosci. 2006 Feb;13(2):218-23. doi: 10.1016/j.jocn.2005.01.012. Epub 2006 Feb 3.
From December 2002 to January 2004, 30 patients (20 men and 10 women; mean age 36.8 years [+/- 14.9 years]) with preoperative Glasgow Coma Scale scores of 8 or less underwent emergency haematoma evacuation surgery and continuous intracranial pressure (ICP), cerebral perfusion pressure (CPP) and mean arterial blood pressure monitoring to determine ICP and CPP thresholds to predict patient outcomes. Receiver-operating characteristic (ROC) curves were plotted. Using the ROC curve, the diagnostic accuracy is given by the area under the curve and at the point on the curve farthest from the diagonal, which indicates the threshold value. The results showed that the initial ICP for unfavourable outcomes was 47.4 +/- 21.4 mmHg, resulting in a CPP of 22.8 +/- 12.83 mmHg. The initial ICP for favourable outcomes was 26.4 +/- 10.1 mmHg, resulting in a CPP of 48.8 +/- 13.4 mmHg. The CPP had the largest area under the ROC curve in all stages of the operation, corresponding to intraoperative CPP thresholds of 37 mmHg (initial), 51.8 mmHg (intraoperative) and 52 mmHg (after scalp closure). The ROC curve analysis showed that CPP was a better predictor of outcome than ICP.
2002年12月至2004年1月，30例术前格拉斯哥昏迷量表评分在8分及以下的患者（20例男性，10例女性；平均年龄36.8岁[±14.9岁]）接受了急诊血肿清除手术，并进行了持续颅内压（ICP）、脑灌注压（CPP）和平均动脉血压监测，以确定预测患者预后的ICP和CPP阈值。绘制了受试者操作特征（ROC）曲线。利用ROC曲线，诊断准确性由曲线下面积以及曲线上离对角线最远的点给出，该点即阈值。结果显示，不良预后的初始ICP为47.4±21.4 mmHg，导致CPP为22.8±12.83 mmHg。良好预后的初始ICP为26.4±10.1 mmHg，导致CPP为48.8±13.4 mmHg。在手术的所有阶段，CPP在ROC曲线下的面积最大，对应术中CPP阈值为37 mmHg（初始）、51.8 mmHg（术中）和52 mmHg（头皮缝合后）。ROC曲线分析表明，CPP比ICP更能预测预后。
