心肌肌钙蛋白水平变化及肺气体交换紊乱作为蛛网膜下腔出血动脉瘤患者短期和长期预后的预测指标

Changes in the level of cardiac troponine and disorders in pulmonary gas exchange as predictors of short- and long-term outcomes of patients with aneurysm subarachnoid haemorrhage.

作者信息

Burzyńska Małgorzata, Uryga Agnieszka, Kasprowicz Magdalena, Kędziora Jarosław, Szewczyk Ewa, Woźniak Jowita, Jarmundowicz Włodzimierz, Kübler Andrzej

机构信息

a Department of Anaesthesiology and Intensive Care , Wroclaw Medical University , Wroclaw , Poland.

b Department of Biomedical Engineering, Faculty of Fundamental Problems of Technology , Wroclaw University of Science and Technology , Wroclaw , Poland.

出版信息

Br J Neurosurg. 2017 Dec;31(6):653-660. doi: 10.1080/02688697.2017.1339301. Epub 2017 Jun 21.

DOI:10.1080/02688697.2017.1339301

PMID:28633535

Abstract

SUBJECT

Cardiopulmonary abnormalities are common after aneurysmal subarachnoid haemorrhage (aSAH). However, the relationship between short- and long-term outcome is poorly understood. In this paper, we present how cardiac troponine elevations (cTnI) and pulmonary disorders are associated with short- and long-term outcomes assessed by the Glasgow Outcome Scale (GOS) and Extended Glasgow Outcome Scale (GOSE).

METHODS

A total of 104 patients diagnosed with aSAH were analysed in the study. The non-parametric U Mann-Whitney test was used to evaluate the difference between good (GOS IV-V, GOSE V-VIII) and poor (GOS I-III, GOSE I-IV) outcomes in relation to cTnI elevation and pulmonary disorders. Outcome was assessed at discharge from the hospital, and then followed up 6 and 12 months later. Pulmonary disorders were determined by the PaO/FiO ratio and radiography. The areas under the ROC curves (AUCs) were used to determine the predictive power of these factors.

RESULTS

In the group with good short-term outcomes cTnI elevation on the second day after aSAH was significantly lower (p = .00007) than in patients with poor short-term outcomes. The same trend was observed after 6 months, although there were different results 12 months from the onset (p = .024 and n.s., respectively). A higher peak of cTnI was observed in the group with a pathological X-ray (p = .008) and pathological PaO/FiO ratio (p ≪ .001). cTnI was an accurate predictor of short-term outcomes (AUC = 0.741, p ≪ .001) and the outcome after 6 months (AUC = 0.688, p = .015).

CONCLUSION

The results showed that cardiopulmonary abnormalities perform well as predictive factors for short- and long-term outcomes after aSAH.

摘要

主题

心肺异常在动脉瘤性蛛网膜下腔出血（aSAH）后很常见。然而，短期和长期预后之间的关系尚不清楚。在本文中，我们阐述了心肌肌钙蛋白升高（cTnI）和肺部疾病与通过格拉斯哥预后量表（GOS）和扩展格拉斯哥预后量表（GOSE）评估的短期和长期预后之间的关联。

方法

本研究共分析了104例诊断为aSAH的患者。采用非参数U曼-惠特尼检验来评估cTnI升高和肺部疾病与良好（GOS IV-V，GOSE V-VIII）和不良（GOS I-III，GOSE I-IV）预后之间的差异。在出院时评估预后，然后在6个月和12个月后进行随访。通过动脉血氧分压/吸入氧分数值（PaO/FiO）和影像学检查确定肺部疾病。采用ROC曲线下面积（AUC）来确定这些因素的预测能力。

结果

在短期预后良好的组中，aSAH后第二天的cTnI升高显著低于短期预后不良的患者（p = 0.00007）。6个月后观察到相同趋势，尽管发病12个月后结果不同（分别为p = 0.024和无统计学意义）。在胸部X线检查异常（p = = 0.008）和PaO/FiO比值异常（p ≪ 0.001）的组中观察到更高的cTnI峰值。cTnI是短期预后（AUC = 0.741，p ≪ 0.001）和6个月后预后（AUC = 0.688，p = 0.015）的准确预测指标。