Abstract:

Objective: To explore and evaluate the application value of pressure reactivity index (PRx) based on invasive intracranial pressure (ICP) and mean flow index (Mx) based on transcranial Doppler ultrasonography (TCD) noninvasive monitoring in severe traumatic brain injury (sTBI). Methods: The clinical data of 64 patients with sTBI treated in He'nan Provincial People's Hospital from January 2024 to February 2025 were included. According to the Glasgow Outcome Scale (GOS), the patients were divided into the good prognosis (GOS score 3-5) group (n = 31) and the poor prognosis (GOS score 1-2) group (n = 33). All patients received ICP monitoring immediately after surgery for 3-7 d. The ICP-related indicators including average ICP, cerebral perfusion pressure (CPP) and PRx were collected, and the ICP dose with a threshold of 20 mm Hg (D_ICP20) was obtained. All patients were monitored by TCD with an interval of ≥ 3 d immediately after operation, and the specific value of Mx was obtained. Univariate and multivariate Logistic regression analyses were used to analyze of influencing factors for 6-month post-discharge prognostic outcomes in patients with sTBI. The receiver operating characteristic (ROC) curve was further drawn, and the area under the curve (AUC) was calculated to evaluate the ability of each parameter to predict poor prognosis. Pearson correlation analysis was used to further analyze the correlation between PRx and Mx. Results: Logistic regression analysis showed that higher ICP (OR = 2.439, 95%CI: 1.077-5.526; P = 0.033), higher PRx (OR = 14.932, 95%CI: 2.215-100.666; P = 0.005) and higher Mx (OR = 3.087, 95%CI: 1.145-8.324; P = 0.026) were risk factors for 6-month post-discharge prognostic outcomes in patients with sTBI. The AUC of ICP, PRx and Mx was 0.912 (95%CI: 0.814-0.968, P = 0.033), 0.958 (95%CI: 0.876-0.992, P = 0.005) and 0.859 (95%CI: 0.749-0.933, P = 0.026), and the prediction efficiency of the three was the same (Z = 0.850, P = 0.396; Z = 1.128, P = 0.259; Z = 1.856, P = 0.063). Pearson correlation analysis showed that the overall correlation between the mean values of all records of PRx and Mx was moderate (r = 0.521, P = 0.000). Conclusions: ICP, PRx and Mx were the risk factors for 6-month post-discharge prognostic outcomes in patients with sTBI. Mx can be used as a noninvasive way to evaluate the cerebral autoregulation (CA) function of patients with sTBI, and has a certain predictive ability for the prognosis. There was a moderate correlation between PRx and Mx, suggesting that they provide different information of CA function.

Key words: Brain injuries, traumatic, Cerebrovascular circulation, Intracranial pressure, Ultrasonography, Doppler, transcranial, Prognosis

摘要：

目的: 探究基于有创颅内压（ICP）计算的血管压力反应性指数（PRx）与经颅多普勒超声（TCD）无创监测的平均血流指数（Mx）对重型颅脑创伤的预后预测价值。方法: 纳入2024年1月至2025年2月河南省人民医院收治的64例重型颅脑创伤患者，根据出院后6个月Glasgow预后分级分为预后良好（3~5分）组（31例）及预后不良（1~2分）组（33例）。术后即刻进行连续3~7 d的颅内压监测，收集连续监测的颅内压相关数据包括平均颅内压、脑灌注压、PRx，并获得阈值为20 mm Hg的颅内压剂量（D_ICP20）；同时进行间断≥ 3 d的TCD监测，获得Mx。采用单因素和多因素Logistic回归分析筛查重型颅脑创伤患者出院后6个月预后不良的影响因素，绘制受试者工作特征（ROC）曲线并计算曲线下面积，评估各参数的预测效能；采用Pearson相关分析探讨PRx与Mx的相关性。结果: Logistic回归分析显示，颅内压（OR=2.439，95% CI：1.077~5.526；P=0.033）、PRx（OR=14.932，95% CI：2.215~100.666；P=0.005）和Mx（OR=3.087，95% CI：1.145~8.324；P=0.026）较高是重型颅脑创伤患者出院后6个月预后不良的危险因素。ROC曲线显示，颅内压、PRx和Mx的曲线下面积分别为0.912（95% CI：0.814~0.968，P=0.033）、0.958（95% CI：0.876~0.992，P=0.005）和0.859（95% CI：0.749~0.933，P=0.026），三者的预测效能相当（Z=0.850，P=0.396；Z=1.128，P=0.259；Z=1.856，P=0.063）。Pearson相关分析显示，PRx与Mx所有记录的平均值之间的总体相关性呈中等相关（r=0.521，P=0.000）。结论: 颅内压、PRx和Mx均为重型颅脑创伤患者出院后6个月预后不良的危险因素；Mx可作为一种无创方式评估重型颅脑创伤患者脑血流自动调节能力，对预后有一定预测效能；Mx与PRx的变化趋势呈中等相关，提示二者分别提供脑血流自动调节能力的不同信息。

关键词: 脑损伤，创伤性, 脑血管循环, 颅内压, 超声检查，多普勒，经颅, 预后