入院无反应中瞳孔光反射的定量评估,BMC Neurology

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入院无反应中瞳孔光反射的定量评估
BMC Neurology ( IF 2.2 ) Pub Date : 2021-06-24 , DOI: 10.1186/s12883-021-02275-9
Hyunjo Lee ₁ , Soh Hyun Choi ₁ , Bobin Park ₁ , Yoon-Hee Hong ₁ , Han-Bin Lee ₁ , Sang-Beom Jeon ₁

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出现院内反应迟钝的患者应及时处理以避免临床恶化。通过瞳孔光反射进行瞳孔检查是对无反应患者进行初步评估的金标准方法。然而，目前的照耀和主观描述的方法往往表现出较差的可靠性。本研究的目的是探讨瞳孔光反射的定量测量是否有助于检测脑疝综合征和预测因非神经系统原因入院后出现住院反应迟钝的患者的神经系统结果。这是一项基于登记处的观察性研究，针对激活牙山医疗中心（韩国首尔）神经学快速反应小组的患者。住院无反应被定义为在住院期间由 ACDU（警觉、困惑、昏昏欲睡和无反应）量表评估的新发展的无反应状态。分析了人口统计学、合并症、瞳孔测量参数，包括神经学瞳孔指数、脑疝综合征、住院死亡率和 3 个月时的改良 Rankin 量表。在连续 214 名入院无反应的患者中，37 名 (17%) 患有脑疝综合征。用于检测脑疝综合征的神经学瞳孔指数的最佳临界值为 < 1.6（特异性，91% [95% 置信区间 (CI) = 86–95]；敏感性，49% [95% CI = 32–66]））。住院死亡率为28%（59/214）；在调整脑疝综合征的存在后，神经学瞳孔指数与院内死亡率呈负相关（调整后的比值比 = 0.77，95% CI = 0.62–0.96）。76% (152/201) 的患者在 3 个月时观察到神经功能不良（改良 Rankin 量表≥4）；在调整临床变量后，神经学瞳孔指数与较差的神经学结果呈负相关（调整后的优势比 = 0.67，95% CI = 0.49–0.90）。瞳孔光反射的定量测量可能有助于早期检测出院后反应迟钝的患者可能危及生命的神经系统疾病。76% (152/201) 的患者在 3 个月时观察到神经功能不良（改良 Rankin 量表≥4）；在调整临床变量后，神经学瞳孔指数与较差的神经学结果呈负相关（调整后的优势比 = 0.67，95% CI = 0.49–0.90）。瞳孔光反射的定量测量可能有助于早期检测出院后反应迟钝的患者可能危及生命的神经系统疾病。76% (152/201) 的患者在 3 个月时观察到神经功能不良（改良 Rankin 量表≥4）；在调整临床变量后，神经学瞳孔指数与较差的神经学结果呈负相关（调整后的优势比 = 0.67，95% CI = 0.49–0.90）。瞳孔光反射的定量测量可能有助于早期检测出院后反应迟钝的患者可能危及生命的神经系统疾病。

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Quantitative assessments of pupillary light reflexes in hospital-onset unresponsiveness

Patients who develop hospital-onset unresponsiveness should be promptly managed in order to avoid clinical deterioration. Pupillary examination through pupillary light reflex is the gold standard method in the initial evaluation of unresponsive patients. However, the current method of shining light and subjective description often shows poor reliability. The objective of this study is to explore whether a quantitative measurement of pupillary light reflexes is useful in detecting brain herniation syndrome and predicting neurological outcomes in patients who developed hospital-onset unresponsiveness after admission for non-neurological reasons. This was a registry-based observational study on patients who activated the neurological rapid response team at Asan Medical Center (Seoul, Korea). Hospital-onset unresponsiveness was defined as a newly developed unresponsive state as assessed by the ACDU (Alert, Confused, Drowsy, and Unresponsive) scale during the hospital stay. Demographics, comorbidities, pupillometry parameters including Neurological Pupil index, brain herniation syndrome, in-hospital mortality, and modified Rankin Scale at 3-months were analyzed. In 214 consecutive patients with hospital-onset unresponsiveness, 37 (17%) had brain herniation syndrome. The optimal cut-off value of Neurological Pupil index for detecting brain herniation syndrome was < 1.6 (specificity, 91% [95% confidence interval (CI) = 86–95]; sensitivity, 49% [95% CI = 32–66]). The in-hospital mortality rate was 28% (59/214); the Neurological Pupil index was negatively associated with in-hospital mortality after adjustments for the presence of brain herniation syndrome (adjusted odds ratio = 0.77, 95% CI = 0.62–0.96). Poor neurological outcomes (modified Rankin Scale ≥4) at 3 months was observed in 76% (152/201) of the patients; the Neurological Pupil index was negatively associated with poor neurological outcomes after adjustments for clinical variables (adjusted odds ratio = 0.67, 95% CI = 0.49–0.90). Quantitative measurements of pupillary light reflexes may be useful for early detection of potentially life-threatening neurological conditions in patients with hospital-onset unresponsiveness.

更新日期：2021-06-24

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