重型颅脑损伤死亡相关因素分析

Analysis of factors related to the mortality of acute severe traumatic brain injury

目的总结重型颅脑损伤患者的死亡率,探讨死亡的相关因素。方法建立颅脑损伤数据库,总结我科2000年1月至2005年12月之间收治的重型颅脑损伤患者的临床诊疗情况,并对影响患者死亡的相关临床特点进行比较分析。结果213例重型颅脑损伤患者中,车祸致伤152例(71.4%),手术103例(48.4%),其中血肿清除加标准大骨瓣减压术75例。GCS 3～5分患者死亡率61.2%,GCS 6～8分患者死亡率19.1%,总死亡率39.4%。外院转入99例(46.5%)。直接来院及入院时间在4h以内的患者死亡率明显下降。血糖明显升高(>13mmol/L)、上消化道出血和严重的低氧血症可以增加患者死亡率,尤其是晚期死亡者。结论在强化现场急救、规范住院治疗的基础上,完善转诊机制、减少转院、缩短入院时间,对降低重型颅脑损伤死亡率、尤其是早期(24h之内)的死亡,有重要意义。加强继发性损伤的治疗、预防并及时准确处理并发症,可以降低患者的中晚期死亡率。

Objective To analyze the mortality of acute severe traumatic brain injury （TBI） and the factors influencing the head injury outcome. Methods 213 cases of severe TBI were involved in the data bank of traumatic brain injury from 2000 to 2005. The clinical data and mortality was analyzed, especially the factors that influence the death of severe TBI. Results In 213 cases of severe TBI, men accounted for 81.7%, with the mean （40.6 ±18.3） years old. The most common cause was motor vehicle accident with 152 cases （71.4%）. 103 cases （48.4%） received surgical treatment, in which hematoma evacuation with standard large bone flap decompression were performed in 75 cases. The mortality of 103 cases with GCS 3 -5 was 61.2%, 110 cases with GCS 6 -8 was 19.1%, the total mortality was 39.4%. The patients came from the other hospital occupied 46.5%. If patients come to our hospital directly and the in-hospital time was less than 4 hours, the mortality decreased markedly. The increased blood sugar, gastrointestinal bleeding, pulmonary complications can also increase the mortality of severe TBI, especially in the late death group. Conclusions Standardizing the treatment of severe TBI, shorten the in-hospital time and patient transportation between hospitals may decrease the mortality of severe TBI, especially in the early death group. Prevention and correct treatment of complications may reduce the late death of severe TBI.