| 韩耀国,孙跃喜,叶明荣,等.经颅多普勒超声评估脓毒症相关性谵妄的临床研究[J].安徽医药,2018,22(11):2191-2194. |
| 经颅多普勒超声评估脓毒症相关性谵妄的临床研究 |
| Clinical evaluation of transcranial Doppler predicting sepsis-associated delirium |
| 投稿时间：2017-02-21 |
| DOI： |
| 中文关键词: 脓毒症 脓毒症相关性谵妄 经颅多普勒超声 搏动指数 |
| 英文关键词: Sepsis Sepsis-associated delirium Transcranial doppler Pulsatility indexneoplasms Radiotherapy,intensity-modulated Review |
| 基金项目:上海市浦东新区卫生系统重点学科建设资助(PWZXK2017-15);院新星资助项目(XX2015-11) 经颅多普勒超声评估脓毒症相关性谵妄的临床研究韩耀国,孙跃喜,叶明荣,陈刚,张涛,雷鸣(上海中医药大学附属第七人民医院重症医学科,上海 200137) |
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| 中文摘要: |
| 目的 采用经颅多普勒超声(TCD)测量脓毒症患者搏动指数(PI)及脑血流指数(CBFi),明确PI及CBFi预测脓毒症相关性谵妄的价值。方法 选择2015年1月至2016年3月上海中医药大学附属第七人民医院脓毒症患者共42例,使用TCD测量第1天及第3天的PI及CBFi。根据第1天PI值将患者分为两组(高PI组及低PI组)。采用ICU意识模糊评估法(CAM-ICU)每日评估患者的神经功能状态,CAP-ICU阳性即诊断患者为脓毒症相关性谵妄(SAD)。结果 22例(52%)患者出现SAD(CAM-ICU阳性)。75%患者PI值>1.05。第1天的PI值可以预测脓毒症相关性谵妄的发生(AUC=0.90, 95%CI:0.80～0.98,P<0.01)；以PI=1.2为阈值,预测SAD的灵敏度为92%,特异度为86%。logistic回归分析表明PI是与SAD相关的独立危险因素,这种相关性独立于年龄和急性生理和慢性健康状况评估Ⅱ(APACHE Ⅱ)评分(OR:6.24,95% CI:1.14～28.32,P=0.02)。PI高的患者,第1天的大脑中动脉平均血流速度和CBFi更低,且差异有统计学意义(P<0.01)。结论 通过TCD监测脓毒症患者脑血流动力学异常,可以预测SAD的发生。 |
| 英文摘要: |
| Objective To evaluate the role of Transcranial Doppler predicting sepsis-associated delirium.Methods Forty -two septic patients were examined by Transcranial Doppler on the first and third day of sepsis diagnosis in Senventh People's Hospital of Shanghai University of TCM from January 2015 to March 2016.The pulsatility index (PI) and cerebral blood flow index (CBFi) were examined in the middle cerebral artery.Patients underwent a daily assessment with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) test.Results Twenty-two patients (52%) were found to present delirium.The majority of the patients presented a PI>1.05 (75%).PI on the first day (but not the third day) can predict a positive CAM-ICU test in septic patients (AUC=0.90,95% CI:0.80-0.98,P<0.01).PI cut-off value at 1.2,sensitivity:92%,specificity:86%.Multivariable analysis showed that PI on the first day is related to a positive CAM-ICU test independent of age and APACHE Ⅱ score (OR:6.24,95% CI:1.14-28.32,P=0.02).On only the first day,the mean blood velocity in the middle cerebral artery and CBFi were found to be lower in those patients with a high initial PI (P<0.01).Conclusion Cerebral haemodynamic disturbance evaluated by Transcranial Doppler is associated with clinical symptoms of sepsis-associated delirium. |
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