本文關(guān)鍵詞：NSE與BIS監(jiān)測(cè)在評(píng)估重度一氧化碳中毒患者腦功能及預(yù)后中的臨床應(yīng)用　出處：《東南大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2016年01期 　論文類型：期刊論文

  更多相關(guān)文章： 神經(jīng)元特異性烯醇化酶 腦電雙頻指數(shù) 重度一氧化碳中毒 腦神經(jīng)損傷評(píng)估 預(yù)后

【摘要】：目的:探討神經(jīng)元特異性烯醇化酶(neuron-specific enolase,NSE)與腦電雙頻指數(shù)(bispectral index,BIS)的監(jiān)測(cè)在重度一氧化碳中毒患者的腦神經(jīng)損傷評(píng)估及預(yù)后預(yù)測(cè)中的臨床應(yīng)用價(jià)值。方法:采用回顧性研究方法,選取2011年1月至2015年2月開(kāi)封市第二人民醫(yī)院EICU救治的重度一氧化碳中毒患者86例,觀察患者3個(gè)月后腦神經(jīng)功能及預(yù)后情況,按患者轉(zhuǎn)歸結(jié)果分為預(yù)后不良組(n=38)和預(yù)后良好組(n=48例)。入住EICU后,在第1、3、7、15天行患者昏迷評(píng)分(GCS-Pittsburgh scores,G-P評(píng)分),同時(shí)監(jiān)測(cè)BIS指數(shù)及檢測(cè)血清NSE;對(duì)比分析預(yù)后良好組與預(yù)后不良組G-P評(píng)分與BIS均值、血清NSE質(zhì)量濃度差異情況,分析它們之間的相關(guān)性;根據(jù)86例患者臨床監(jiān)測(cè)指標(biāo)繪制受試者工作特征曲線圖(ROC),并計(jì)算曲線下面積(AUC),評(píng)價(jià)其診斷試驗(yàn)的效能。結(jié)果:(1)預(yù)后不良組與預(yù)后良好組兩組比較,BIS值分別為61.05±6.13和80.91±3.00(t=-6.115,P0.01),NSE濃度質(zhì)量分別為(43.53±10.81)和(30.51±6.63)ng·ml-1(t=18.315,P0.01),G-P評(píng)分分別為17.54±2.30和20.81±2.58(t=6.571,P0.01),差異均有統(tǒng)計(jì)學(xué)意義。(2)NSE質(zhì)量濃度與BIS值呈負(fù)相關(guān)(r=-0.536,P0.01),NSE質(zhì)量濃度與G-P評(píng)分呈負(fù)相關(guān)(r=-0.255,P0.05),BIS值與G-P評(píng)分呈正相關(guān)(r=0.508,P0.01)。(3)計(jì)算G-P評(píng)分、BIS值、NSE質(zhì)量濃度的AUC分別是0.832、0.942、0.874。預(yù)后不良患者:當(dāng)G-P評(píng)分≤16.9時(shí)敏感性為95.8%,特異性為69.8%;當(dāng)BIS值≤65時(shí)敏感性為100%,特異性為60.1%。NSE質(zhì)量濃度≥33.6 ng·ml-1為截?cái)帱c(diǎn)評(píng)價(jià)患者腦神經(jīng)損傷及預(yù)后評(píng)估的敏感性為88.6%,特異性為91.2%;當(dāng)NSE≥50.8 ng·ml-1時(shí)敏感性為49.2%,特異性為100%。結(jié)論:NSE與BIS監(jiān)測(cè)對(duì)患者腦神經(jīng)損傷評(píng)估有較高敏感性及特異性,并對(duì)預(yù)后測(cè)評(píng)有極其重要臨床意義。
[Abstract]:Objective: To investigate the neuron specific enolase (neuron-specific enolase, NSE) and bispectral index (bispectral index, BIS) in the monitoring of brain damage assessment and prediction of the prognosis of patients with the clinical value of severe carbon monoxide poisoning. Methods: a retrospective study method, 86 cases were selected from January 2011 to February 2015 in Kaifeng Second People's Hospital EICU treatment of severe carbon monoxide poisoning patients were observed 3 months after the nerve function and prognosis of patients, according to the outcome of the results into the poor prognosis group (n=38) and good prognosis group (n=48 cases). After admission to EICU, in the 1,3,7,15 days in patients with coma score (GCS-Pittsburgh score, scores, G-P) and BIS index and monitoring detection of serum NSE; comparative analysis of the good prognosis group and poor prognosis group G-P score and BIS mean serum NSE concentration difference, correlation analysis between them ;鏍規(guī)嵁86渚嬫?zhèn)ｈ�呬復(fù)搴婄洃嫻嬫寚鏍囩粯鍒跺彈璇曡，

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