RESUMO
Background: Patients with severe neurological conditions are at high risk during withdrawal and extubation, so it is important to establish a model that can quantitatively predict the risk of this procedure. Methods: By analyzing the data of patients with traumatic brain injury and tracheal intubation in the ICU of the affiliated hospital of Hangzhou Normal University, a total of 200 patients were included, of which 140 were in the modeling group and 60 were in the validation group. Through binary logistic regression analysis, 8 independent risk factors closely related to the success of extubation were screened out, including age ≥ 65 years old, APACHE II score ≥ 15 points, combined chronic pulmonary disease, GCS score < 8 points, oxygenation index <300, cough reflex, sputum suction frequency, and swallowing function. Results: Based on these factors, a risk prediction scoring model for extubation was constructed with a critical value of 18 points. The AUC of the model was 0.832, the overall prediction accuracy was 81.5%, the specificity was 81.6%, and the sensitivity was 84.1%. The data of the validation group showed that the AUC of the model was 0.763, the overall prediction accuracy was 79.8%, the specificity was 84.8%, and the sensitivity was 64.0%. Conclusion: These results suggest that the extubation risk prediction model constructed through quantitative scoring has good predictive accuracy and can provide a scientific basis for clinical practice, helping to assess and predict extubation risk, thereby improving the success rate of extubation and improving patient prognosis.
RESUMO
OBJECTIVE: To compare the image quality of spectral CT monochromatic imaging and conventional CT polychromatic imaging for analysing CTAs in patients with cervical cancer. METHODS: In this IRB approved prospective study, 60 patients who had been diagnosed with cervical cancer underwent pelvic arterial CTA between May 2013 and July 2013. They were randomly divided into two groups; one group (30 patients) received 120 kVp polychromatic imaging (conventional CT group) and the other group (30 patients) received spectral CT imaging (spectral CT group), while all patients in both the groups received injections of 1 ml/kg of contrast agent. A total of 101 sets of monochromatic images (40-140 keV) were obtained via data reconstruction in the spectral CT group, and the monochromatic images with the best contrast-to-noise ratio (CNR) between the common iliac artery and pelvic fat (i.e. the best monochromatic energy) were selected. The best monochromatic images for the spectral CT group and the polychromatic images for the conventional CT group were postprocessed and visualised in MIP, VR and CPR mode. The CT attenuation value, noise and CNR of bilateral common iliac arteries were measured with the best monochromatic energy, as well as with 70 keV, in the spectral CT group and in the conventional CT group. The quality of the CT images was evaluated with a 5-point scale. The CTDIvol and the dose-length product (DLP) of the two groups were measured, and the results were statistically analysed. RESULTS: When images were at 50±1 keV, the common iliac artery and pelvic fat had the highest CNR, which was 72.00% higher than the images at 70 keV (P=.001) in the spectral group, and thus, the images at 50±1 keV were considered to have the best monochromatic energy. The average CT value of the internal iliac artery, which had the best monochromatic energy from the spectral CT group, was higher than that of the images from the conventional CT group (603.96±62.68 vs 251.24±28.77; P<.001), and the differences in the CNR (73.97±11.83 vs 45.21±16.63) and the subjective score (3.10±1.73 vs 2.80±1.63) were statistically significant (both P<.05). There were no significant differences in the CTDIvol (10.48±2.86 vs 12.38±1.88 mGy) or the DLP (317.76±95.50 vs 332.25±21.25 mGy cm) between the spectral and the conventional CT groups. CONCLUSION: Monochromatic spectral CT imaging has excellent soft tissue contrast and good spatial resolution and can visualise the arteries and branches supplying the tumours more clearly in patients with cervical cancer. Compared with polychromatic images, monochromatic spectral CT images are higher quality, which helps the treatment of patients with cervical cancer.
