目的 探讨格拉斯哥昏迷量表(GCS)评分和全面无反应性量表(FOUR)评分与脑电双频指数(BIS)及呼吸机相关性肺炎(VAP)的相关性,旨在为临床预防VAP提供帮助.方法 选取2015年7-12月天津市第一中心医院ICU收治的建立人工气道并进行机械通气的患者40例作为研究对象.患者进入ICU 12 h内进行GCS、FOUR评分,同时行24 h BIS监测,记录相关数值,采用国内标准或临床肺部感染积分(CPIS积分)诊断VAP,并追踪患者VAP发生情况.GCS、FOUR评分与BIS及VAP的相关性分别采用Pearson相关分析、Spearman秩相关分析.结果 GCS评分为(8.3±4.0)分,FOUR评分为(8.3±3.7)分,BIS为(69.7±17.6).GCS、FOUR评分均与BIS呈正相关(r值分别为0.761、0.821,P<0.01).GCS评分与早发性VAP无直线相关关系(rs=0.885,P>0.05);GCS评分与晚发性VAP呈高度负相关(rs=-0.994,P<0.01).FOUR评分与早发性VAP呈高度正相关(r=0.992,P<0.01);GCS评分与晚发性VAP呈高度负相关(rs=-0.958,P<0.05).结论 与GCS评分相比,FOUR评分与BIS、VAP的相关性更高,推测FOUR评分更适合用于评估患者的意识障碍程度和预测VAP的发生,且其具有使用简便、便于记忆等优势.%Objective To investigate the correlation of Glasgow Coma Scale(GCS) score and Full Outline of Unresponsiveness(FOUR) score with bispectral index(BIS) and ventilator-associated pneumonia(VAP),in order to give a hand for clinical prevention of VAP.Methods We carried out a study in 40 patients with artificial airway and mechanical ventilation who receiving inpatient treatment in the ICU of Tianjin First Center Hospital from July to December 2015.Within 12 hours after admission to the ICU,they were respectively evaluated by GCS and FOUR,and given BIS monitoring for 24 hours.And the values were recorded.A standard used in China or clinical pulmonary infection score(CPIS) were used to diagnose VAP.And the data about the incidence of VAP of patients were obtained by follow-up.Pearson correlation coefficient and Spearman rank correlation coefficient were used to evaluate the correlation of GCS score and FOUR score with BIS and incidence of VAP.Results The GCS score was(8.3±4.0),FOUR score was(8.3±3.7) and BIS value was (69.7±17.6).The GCS score and FOUR score were positively correlated with BIS value(r=0.761,0.821,P<0.01).There was no linear correlation between GCS score and early-onset VAP(rs=0.885,P>0.05);the correlation of GCS score and late-onset VAP was highly negative(rs=-0.994,P<0.01).FOUR score had a highly positive correlation with early-onset VAP(rs=0.992,P<0.01);but it had a highly negative correlation with late-onset VAP(rs=-0.958,P<0.05).Conclusion Compared with the GCS score,FOUR score is more significantly associated with BIS,VAP,which can provide moderately accurate assessment of the level of disorder of consciousness and prediction of the incidence of VAP.Moreover,it is easy to use and memorize,so it may could be used as a simple and effective tool for assessing the level of disorder of consciousness and predicting the incidence of VAP.
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