格拉斯哥昏迷-瞳孔反应评分在ICU重型颅脑损伤患者中的临床应用价值
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摘要
目的:探究格拉斯哥-瞳孔反应(Glasgow Coma Scale-Pupil Response,GCS-P)评分在重症医学科(ICU)重型颅脑损伤(severetraumaticbraininjur y,sTBI)患者中的临床实用价值。方法:通过回顾安徽医科大学第三附属医院ICU收治的160名sTBI患者的一般资料,分析GCS评分、P评分、G CS-P评分分别与28d病死率、根据伤后第3个月G OS预后评分评估的不良预后比例的相关性。结果:GCS评分、P评分、GCS-P评分均与患者的28 d病死率及伤后第3个月不良预后比例呈负相关。GCS-P评分与病死率、不良预后比例的相关系数均大于GCS评分。GCS评分与GCS-P评分分值相同时,除4分外,GCS-P评分评估出的病死率及不良预后比例更高。GCS评分3分患者病死率及不良预后比例低于GCS评分4分患者,这一结果在GCS-P评分中未观察到。结论:GCS-P评分与病死率及不良预后比例的相关性优于GCS评分,比GCS评分能提供更多信息,评价范围更大,且简单实用,对临床快速评估颅脑损伤患者病情及预后具有重要价值。
Objective: To investigate the clinical value of Glasgow Coma Scale-Pupil Response(GCS-P) score in patients with severe brain injury in intensive care unit(ICU). Methods: We reviewed the general data of 160 patients with severe brain injury admitted to ICU in our hospital, and analyzed the correlation between GCS score, P score, GCS-P score and 28-day mortality rate, and the unfavorable late outcomes on the GOS score in the 3 rd month after injury. Results: Separately, the GCS score, P score, and GCS-P score were each negatively correlated with the 28-day mortality rate and the unfavorable late outcomes on the GOS score in the 3 rd month after injury. The correlation coefficient between GCS-P score and mortality rate and unfavorable late outcomes rate was greater than GCS score. When the GCS score is the same as the GCS-P score, in addition to 4 points, the GCS-P score has a higher mortality rate and unfavorable late outcomes rate. Patients with a GCS score of 3 points had a lowermortality rate and a lower unfavorable late outcomes rate than patients with a GCS score of 4 points. But the result was not observed in the GCS-P score. Conclusion: The correlation between GCS-P score and mortality rate and unfavorable late outcomes rate is better than GCS score. It provides more information than GCS score. The evaluation scope is larger, and it is simple and practical. It is of great value for clinical rapid assessment of the condition and prognosis of patients with brain injury.
Objective: To investigate the clinical value of Glasgow Coma Scale-Pupil Response(GCS-P) score in patients with severe brain injury in intensive care unit(ICU). Methods: We reviewed the general data of 160 patients with severe brain injury admitted to ICU in our hospital, and analyzed the correlation between GCS score, P score, GCS-P score and 28-day mortality rate, and the unfavorable late outcomes on the GOS score in the 3 rd month after injury. Results: Separately, the GCS score, P score, and GCS-P score were each negatively correlated with the 28-day mortality rate and the unfavorable late outcomes on the GOS score in the 3 rd month after injury. The correlation coefficient between GCS-P score and mortality rate and unfavorable late outcomes rate was greater than GCS score. When the GCS score is the same as the GCS-P score, in addition to 4 points, the GCS-P score has a higher mortality rate and unfavorable late outcomes rate. Patients with a GCS score of 3 points had a lowermortality rate and a lower unfavorable late outcomes rate than patients with a GCS score of 4 points. But the result was not observed in the GCS-P score. Conclusion: The correlation between GCS-P score and mortality rate and unfavorable late outcomes rate is better than GCS score. It provides more information than GCS score. The evaluation scope is larger, and it is simple and practical. It is of great value for clinical rapid assessment of the condition and prognosis of patients with brain injury.
引文
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13.Jennett B,Teasdale G,Braakman R,et al.Predicting outcome in individual patients after severe head injury[J].Lancet,1976,1(7968):1031-1034.
14.Moskopp D,St?hle C,Wassmann H:Problems of the Glasgow Coma Scale with early intubated patients[J].Neurosurg Rev,1995,18(4):253-257.
15.Osler T,Cook A,Glance LG,et al.The di?erential mortality of Glasgow Coma Score in patients with and without head injury[J].Injury,2016,47(9):1879-1885.
16.Brennan PM,Murray GD.Simplif y ing the use of prognostic information in traumatic brain injury.Part 1:The GCS-Pupils score:an extended index of clinical severity[J].J Neurosurg,2018,128(6):1612-1620.
17.贾建平,陈生弟.神经病学[M].北京:人民卫生出版社,2008.JIA Jianping,Chen Shengdi.Neurology[M].Beijing:People’s Medical Publishing House,2008.
2.江基尧.中国颅脑创伤外科学的进步与不足[J].中华神经创伤外科电子杂志,2015,1(1):4-6.JIANG Jiyao.Progress and deficiency of traumatic trauma in China[J].Chinese Journal of Neurotraumatic Surgery.Electronic Edition,2015,1(1):4-6.
3.Zhou L,Talebian A,Meakin SO.The signaling adapter,FRS2,facilitates neuronal branching in primary cortical neurons via both Grb2-and Shp2-dependent mechanisms[J].J Mol Neurosci,2015,55(3):663-677.
4.Teasdale G,Jennett B.Assessment of coma and impaired consciousness.A practical scale[J].Lancet,1974,2(7872):81-84.
5.Teasdale G,Jennett B.Assessment and prognosis of coma after head injury[J].Acta Neurochir(Wien),1976,34(1/4):45-55.
6.Teasdale G,Murray G,Parker L,et al.Adding up the Glasgow Coma Score[J].Acta Neurochir Suppl(Wien),1979,28(1):13-16.
7.Teasdale G,Maas A,Lecky F,et al.The Glasgow Coma Scale at 40years:standing the test of time[J].Lancet Neurol,2014,13(8):844-854.
8.Wijdicks EF,Bamlet WR,Maramattom BV,et al.Validation of a new coma scale:the FOUR score[J].Ann Neurol,2005,58(4):585-593.
9.Marion DW,Carlier PM.Problems with initial Glasgow Coma Scale assessment caused by prehospital treatment of patients with head injuries:results of a national survey[J].J Trauma,1994,36(1):89-95.
10.Nell V,Yates DW,Kruger J.An extended Glasgow Coma Scale(GCS-E)with enhanced sensitivity to mild brain injury[J].Arch Phys Med Rehabil,2000,81(5):614-617.
11.Born JD.The Glasgow-Liège Scale.Prognostic value and evolution of motor response and brain stem reflexes after severe head injury[J].Acta Neurochir(Wien),1988,91(1/2):1-11.
12.Kasprowicz M,Burzynska M,Melcer T.A comparison of the Full Outline of UnResponsiveness(FOUR)score and Glasgow Coma Score(GCS)in predictive modelling in traumatic brain injury[J].Br JNeurosurg,2016,30(2):211-220.
13.Jennett B,Teasdale G,Braakman R,et al.Predicting outcome in individual patients after severe head injury[J].Lancet,1976,1(7968):1031-1034.
14.Moskopp D,St?hle C,Wassmann H:Problems of the Glasgow Coma Scale with early intubated patients[J].Neurosurg Rev,1995,18(4):253-257.
15.Osler T,Cook A,Glance LG,et al.The di?erential mortality of Glasgow Coma Score in patients with and without head injury[J].Injury,2016,47(9):1879-1885.
16.Brennan PM,Murray GD.Simplif y ing the use of prognostic information in traumatic brain injury.Part 1:The GCS-Pupils score:an extended index of clinical severity[J].J Neurosurg,2018,128(6):1612-1620.
17.贾建平,陈生弟.神经病学[M].北京:人民卫生出版社,2008.JIA Jianping,Chen Shengdi.Neurology[M].Beijing:People’s Medical Publishing House,2008.