【摘要】 目的 本研究旨在分析CT评估脓毒症急性期脑萎缩及其结果与危险因素和预后的关系。方法入选ICU的脓毒症患者在住院期间至少接受两次头部CT扫描(n=48)。使用自动分割方法估计脑体积,并记录两次扫描之间脑体积的任何变化。比较两组患者机械通气的使用和持续时间、ICU住院时间、住院时间和病死率。结果 脑萎缩组42例患者的脑体积均明显缩小(首次CT扫描:1.041±0.123 L,第二次CT扫描:1.002±0.121L,t(41)=9.436,P<0.001)。在31天的中位数中,脑萎缩组两次CT扫描之间的脑体积平均百分比变化为-3.7%,相当于38.5 cm~3的脑体积。脑萎缩组接受机械通气的例数图5.2%比66.7%;P=0.02)和机械通气时间的中位数(28[IQR15-57]d比15[IQR0-25]d,P=0.04)显著高于无脑萎缩组。结论 许多严重脓毒症的ICU患者出现长期的精神状态改变和神经学后遗症,表现为脑萎缩的迹象。快速进行性脑萎缩的患者更有可能需要机械通气。更多还原

【Abstract】 Objective The purpose of this study was to analyze the relationship between CT assessment of acute cerebral atrophy in sepsis and its risk factors and prognosis,in order to provide reference for clinical diagnosis and treatment.Methods Patients with sepsis enrolled in ICU underwent at least two head CT scans during hospitalization(n=48).A first head CT scan is routinely performed upon admission,and a second and subsequent head CT scan is performed when long-term disturbance of consciousness or neurological abnormalities are observed.The automatic segmentation method was used to estimate brain volume and any changes in brain volume between scans were recorded.Patients with <0%brain volume change from the first scan to the second scan were defined as "brain atrophy group"(n=42),and patients with≥0% were defined as no brain atrophy group"(n=6).The use and duration of mechanical ventilation,length of stay in ICU,length of stay and mortality were compa red between the two groups.Results The brain volume of 42 patients in the cerebral atro p hy group was significa ntly reduced(the first CT scan:1.04110.123 L,the second CT scan:1.00210.121 L,t(41)=9.436,P<0.001).Over a median of 31 days,the mean percentage change in brain volume between CT scans in the brain atrophy group was-3.7%,equivalent to 38.5 cm3 brain volume.The number of patients receiving mechanical ventilation in cerebral atrophy group(95.2% vs.66.7%;P=0.02) and the median duration of mechanical ventilation(28[IQR15-57]d vs.15[IQRO-25]d,P=0.04) were significantly higher than those in the group without cerebral atrophy.Condusion Many ICU patients with severe sepsis develop long-term altered mental status and neurological sequelae,with signs of brain atrophy.Patients with rapidly progressive brain atrophy are more likely to require mechanical ventilation.更多还原