Narcotrend指数对昏迷患者意识障碍程度的量化评定及预后评估价值研究

doi:10.3969/j.issn.1006-6233.2018.01.017

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摘要 目的: 分析Narcotrend指数对昏迷患者意识障碍程度的量化评定及预后评估价值。方法: 选取2016年1月至2017年2月本院重症医学科收治的42例重症昏迷患者,分析刺激前NT与APACHE Ⅱ、GCS评分相关性、刺激前后NT与GOS评分相关性、刺激前后NT预测患者预后。结果: 刺激前患者NT值为(56.62±25.59),GCS为(4.55±0.80)分,APACHE Ⅱ为(28.57±7.46)分,刺激前NT与GCS评分呈现正相关(相关系数r=0.881,P<0.001),与APACHE Ⅱ呈现负相关(相关系数r=0.-952,P<0.001),刺激后患者NT值为(61.72±29.87),GOS为(2.43±1.35)分,刺激前后NT与GOS评分均呈现显著正相关(r=0.836,P<0.001,r=0.,905,P<0.001),刺激前NT值的曲线下面积为0.916,95%可信区间为0.833~0.999,预测昏迷患者良好预后的最佳截点为59.67,此时灵敏度为92.9%,特异度为71.4%,漏诊率为7.1%,误诊率为28.6%,刺激后NT值的曲线下面积为0.957,95%可信区间为0.000~1.000,预测昏迷患者良好预后的最佳截点为74.58,此时灵敏度为97.3%,特异度为92.9%,漏诊率为2.7%,误诊率为7.1%,刺激前后患者NT值预测昏迷患者良好预后曲线下面积分别为0.916、0.957均>0.9,NT值预测昏迷患者良好预后准确性较高。结论: 昏迷患者的Narcotrend指数与GCS、APACHE Ⅱ评分显著相关,均能够用来评价患者的意识程度以及评价昏迷患者的预后,尤其是刺激后NT值评估昏迷患者的预后灵敏度、特异度较刺激前NT值均提高,且漏诊率和误诊率降低。

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关键词 ： Narcotrend指数, 昏迷, 意识障碍, 预后

Abstract：Objective: To explore the quantitative assessment and prognostic value of the Narcotrend index for the degree of disturbance of consciousness in coma patients. Methods: 42 severe comatose patients admitted to our department of critical care medicine from January 2016 to February 2017 were selected. The correlation between NT and APACHE II and GCS score before and after stimulation, the correlation between NT and GOS score before and after stimulation, and prognosis of NT before and after stimulation were analyzed. Results: The NT value of the patients was (56.62 ± 25.59), GCS was (4.55 ± 0.80), APACHE II was (28.57 ± 7.46), and there was a positive correlation between NT and GCS before stimulation (correlation coefficient r = 0.881, P <0.001). The NT value of the patients was (61.72 ± 29.87), the GOS was (2.43 ± 1.35), and the NT and GOS scores before and after stimulation were significantly correlated with APACHE II (correlation coefficient r=0.-952, P <0.001, r=0.905, P<0.001).The area under the curve of NT before stimulation was 0.916, 95% confidence interval was 0.833~ 0.999, and coma patients were predicted The optimal cut-off rate was 59.67, the sensitivity was 92.9%, the specificity was 71.4%, the missed diagnosis rate was 7.1%, the misdiagnosis rate was 28.6%, and the area under the curve of NT value after stimulation was 0.957, 95% The optimal cut-off rate was 74.58, the sensitivity was 97.3%, the specificity was 92.9%, the misdiagnosis rate was 2.7%, the misdiagnosis rate was 7.1%, and the NT value of the patients before and after stimulation was 74.58. The area under the good prognosis curve of the coma patients was 0.916, 0.957> 0.9, the NT value predicted the good prognosis of coma patients Correctness higher. Conclusion: The Narcotrend index of coma patients is significantly correlated with GCS and APACHE II scores, and it can be used to evaluate the prognosis of coma patients. In particular, the NT value of coma patients is better than that before stimulation. The prognosis, sensitivity, specificity are improved, missed diagnosis rate and misdiagnosis rate decreased.

Key words： Narcotrend index Coma Disturbance of consciousness Prognosis

引用本文:

钟映玉, 陈宇冲, 潘挺军, 黄寿新, 肖百芳, 罗文滔. Narcotrend指数对昏迷患者意识障碍程度的量化评定及预后评估价值研究[J]. 河北医学, 2018, 24(1): 69-73.
ZHAONG Yingyu, CHEN Yuchong, PAN Tingjun, et al. Quantitative Evaluation of the Degree of Consciousness Disorder in Coma patients and the Value of Prognostic Evaluation by Narcotrend Index. HeBei Med, 2018, 24(1): 69-73.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2018.01.017 或 http://www.hbyxzzs.cn/CN/Y2018/V24/I1/69

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