Wang Xu, Shao Huanzhang, Wang Cunzhen, Zhang Huifeng, Li Minghang, Ding Mingyue, Yang Ya'nan, Qin Bingyu
Department of Critical Care Medicine, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou 450003, Henan, China. Corresponding author: Qin Bingyu, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Nov;31(11):1368-1372. doi: 10.3760/cma.j.issn.2095-4352.2019.11.011.
To explore the usability of regional saturation of cerebral oxygenation (rScO) combined with percentage of α variability (PAV) in predicting brain function prognosis in patients with traumatic brain injury (TBI).
A retrospective analysis was conducted. The clinical data of patients with TBI who were monitored rScO and bedside quantitative electroencephalogram (qEEG) admitted to intensive care unit (ICU) of Henan Provincial People's Hospital from August 2018 to July 2019 were collected. The rScO, PAV, and Glasgow coma scale (GCS) score were recorded within 72 hours after the TBI. The primary prognostic indicator was the 3-month Glasgow outcome score (GOS) score. The differences between the two groups of poor prognosis of brain function (GOS score 1-3) and good prognosis (GOS score 4-5) were compared. Binary multivariate Logistic regression analysis was used to analyze the correlation between rScO, PAV, GCS score and the prognosis of brain function in patients with TBI. In addition, receiver operating characteristic (ROC) curve was plotted to analyze the predicting value of rScO and PAV only or combination for prognosis of brain function.
A total of 42 patients with TBI were enrolled in the study, with rScO ≥ 0.60 (grade I) in 14 patients, 0.50 ≤ rScO < 0.60 (grade II) in 16 patients, and rScO < 0.50 (grade III) in 12 patients. PAV 3-4 scores (grade I) were detected in 16 patients, 2 scores (grade II) in 17 patients, and 1 score (grade III) in 9 patients. GCS score 9-14 (grade I) were observed in 13 patients, 4-8 (grade II) in 23 patients, and 3 (grade III) in 6 patients; 18 patients had poor prognosis and 24 had good one. The rScO, PAV and GCS scores of the poor-prognosis group were significantly higher than those in the good-prognosis group [rScO with grade III: 55.6% (10/18) vs. 8.3% (2/24), PAV with grade III: 38.9% (7/18) vs. 8.4% (2/24), GCS score with grade III: 27.7% (5/18) vs. 4.1% (1/24)] with significant differences (all P < 0.05). There was no significant difference in other general data including gender, age, total length of hospital stay or acute physiology and chronic health evaluation II (APACHE II) score between the two groups. Binary multivariate Logistic regression analysis showed that rScO and PAV were independent risk factors for prognosis of brain in patients with TBI [rScO: odds ratio (OR) = 4.656, 95% confidence interval (95%CI) was 1.071-20.233, P = 0.040; PAV: OR = 3.525, 95%CI was 1.044-11.906, P = 0.042]. ROC curve analysis showed that both of rScO and PAV had predictive value for the prognosis of brain function in patients with TBI (AUC was 0.796 and 0.780, respectively, both P < 0.01), and rScO combined with PAV had higher predictive value with the AUC of 0.851 (P < 0.01) than rScO or PAV alone, the sensitivity was 94.4% and the specificity was 62.5%.
rScO and PAV were associated with early brain function prognosis in patients with TBI. The combination of two monitoring indicators can reliably assess the prognosis of brain function in patients with TBI.
探讨脑氧饱和度区域（rScO）联合α波变异百分比（PAV）预测创伤性脑损伤（TBI）患者脑功能预后的可行性。
进行回顾性分析。收集2018年8月至2019年7月在河南省人民医院重症监护病房（ICU）接受rScO和床旁定量脑电图（qEEG）监测的TBI患者的临床资料。记录TBI后72小时内的rScO、PAV和格拉斯哥昏迷量表（GCS）评分。主要预后指标为3个月格拉斯哥预后评分（GOS）。比较脑功能预后不良（GOS评分1 - 3）和预后良好（GOS评分4 - 5）两组之间的差异。采用二元多因素Logistic回归分析TBI患者rScO、PAV、GCS评分与脑功能预后的相关性。此外，绘制受试者工作特征（ROC）曲线分析单独或联合rScO和PAV对脑功能预后的预测价值。
共纳入42例TBI患者，rScO≥0.60（I级）14例，0.50≤rScO<0.60（II级）16例，rScO<0.50（III级）12例。PAV 3 - 4分（I级）16例，2分（II级）17例，1分（III级）9例。GCS评分9 - 14分（I级）13例，4 - 8分（II级）23例，3分（III级）6例；预后不良18例，预后良好24例。预后不良组的rScO、PAV和GCS评分显著高于预后良好组[rScO的III级：55.6%（10/18）对8.3%（2/2），PAV的III级：38.9%（7/18）对8.4%（2/24），GCS评分的III级：27.7%（5/18）对4.1%（1/24）]，差异均有统计学意义（均P<0.05）。两组间性别、年龄、住院总时长或急性生理与慢性健康状况评估II（APACHE II）评分等其他一般资料无显著差异。二元多因素Logistic回归分析显示，rScO和PAV是TBI患者脑预后的独立危险因素[rScO：比值比（OR）=4.656，95%置信区间（95%CI）为1.071 - 20.233，P = 0.040；PAV：OR = 3.525，95%CI为1.044 - 11.906，P = 0.042]。ROC曲线分析显示，rScO和PAV对TBI患者脑功能预后均有预测价值（AUC分别为0.796和0.780，均P<0.01），且rScO联合PAV预测价值更高，AUC为0.851（P<0.01），高于单独的rScO或PAV，敏感性为94.4%，特异性为62.5%。
rScO和PAV与TBI患者早期脑功能预后相关。两项监测指标联合可可靠评估TBI患者脑功能预后。
