儿科重症监护病房严重颅脑外伤的预后因素分析

Analysis of Prognositic Factors of Severe Traumatic Brain Injury in Pediatric Intensive Care Unit

目的调查儿科重症监护病房（PICU）影响急性严重颅脑外伤预后的因素。方法2001年1月~2006年9月PICU收治的格拉斯哥昏迷评分（GCS）≤8分且至少存活5 d以上的急性严重颅脑外伤患儿,入院时行血气分析、血压监测,d1、3、5检测血WBC及评估GCS,d1~5检测血糖并行高血糖评分（HS）。结果严重颅脑外伤患儿82例,死亡36例。单因素回归分析显示低血压、低GCS、高血WBC计数和高血糖评分是急性严重颅脑外伤儿童死亡的独立危险因素（Pa〈0.001）,其死亡与性别、年龄和低氧血症无关（Pa〉0.05）。多因素回归分析显示低血压、低GCS和高HS是急性严重颅脑外伤死亡的高危因素。结论低GCS、高HS和低血压是影响急性严重颅脑外伤儿童预后的高危因素。

Objective To explore the prognositic factors of severe traumatic brain injury in pediatric intensive care unit（PICU）.Methods Retrospective analysis was determined in all children addmitted to PICU during Jan.2001 to Sep.2006 with a glasgow coma score（GCS） ≤ 8 and survived time 〉 5 days.Blood gas analysis and blood pressure were determined at admitted day.Meanwhile,peripheral white blood cells at d1,3,5,and blood glucose were measured every day,respectively.GCS at d1,3,5 and hyperglycemia scorce（HS） were evaluated.Results Of the 82 studied patients,36 cases died.Univariate analysis showed that hypotension,lower GCS,higher peripheral white blood cells and HS were the independent death risk factors（Pa〈0.001）,but sex,age and hypoxemia were not associated with risk of children death（Pa〉0.05）.In multivariate logistic regression,the factors significantly associated with an increase in mortality were hypotension,lower GCS and higher HS.Conclusion Lower GCS,higher HS and hypotension are associated with poor outcome of children with severe trauma brain injury.