中、重型创伤性脑损伤患者不同时间窗压力反应性指数(PRx)对预后的预测价值OA

Objective To explore the value of pressure reactivity index(PRx)in different time periods for the prognostic assessment of patients with moderate and severe traumatic brain injury.Methods The clinical data of 50 patients with moderate and severe traumatic brain injury admitted to the Department of Neurosurgery of the People's Hospital of the Inner Mongolia Autonomous Region from November 2022 to January 2024 were retrospectively analyzed,and according to the Glasgow outcome scale(GOS)of the patients at 6 months after discharge,27 cases of good prognostic group,and 23 cases of poor prognostic group.The predictive value of PRx,intracranial pressure(ICP),and admission Glasgow coma scale(GCS)in different time periods of the patients in the two groups were analyzed by receiver operating characteristic(ROC)curves.Results There was no statistically significant difference in age and gender between the two groups,and the GCS of patients in good prognostic group was higher than that of poor prognostic group at the time of admission(P<0.05).The mean PRx of patients in good prognostic group was smaller than that of poor prognostic group at postoperative periods of 0-24 h,24-48 h,48-72 h,72-96 h and 96-120 h(P<0.001).The mean ICP of patients in the good prognostic group was significantly lower than that in the poor prognostic group(P<0.001).PRx had good predictive value for patient prognosis in all time periods(AUC>0.7),with the best predictive efficacy in the 48-72 h time window,with an area under the ROC curve of 0.829(95%CI=0.709-0.948),and a sensitivity of 69.57%,specificity of 92.59%,and Youden's index of 0.622 with the cut-off value set to 0.233,P<0.001.Conclusions The temporal dynamic characteristics of PRx can help to identify the optimal timing of intervention.PRx within each time window had good predictive value for patient prognosis,with 48-72 h mean PRx having the highest value for prognostic assessment and being superior to admission GCS and mean ICP.