高海拔与平原地区颅脑外伤住院患者疾病谱差异的回顾性分析

Disease spectrum difference in patients with craniocerebral injury in high altitude and plain areas

目的比较高海拔与平原地区创伤性脑损伤（traumatic brain injury，TBI）患者的疾病谱差异。方法在“中华创伤数据库”中提取2001—2007年军队医院收治的地方TBI患者病案首页信息。选择10所高海拔地区军队医院（高海拔组）和10所医院级别相同的平原地区军队医院（平原组），比较两组患者一般情况和疾病谱差异。结果高海拔组男性患者比例高于平原组（P〈0．01）；高海拔组患者年龄低于平原组（P〈0．01）；高海拔组汉族患者比例低于平原组（P〈0．叭）；高海拔组急诊人院患者比例低于平原组（P〈0．01）；高海拔组危重患者比例高于平原组（P〈0．01）；高海拔组患者住院天数的中位数低于平原组（P〈0．01）；高海拔组患者手术率低于平原组（P〈0．01）。颅脑外伤疾病顺位依次为颅内器官损伤（排除颅骨骨折），头、颈、躯干开放性外伤，颅骨骨折，神经及脊髓损伤。高海拔组颅脑外伤疾病谱顺位与平原组顺位相同，疾病构成差异具有统计学意义（P〈0．01）。结论高海拔地区TBI患者在人口统计学指标、入院情况以及疾病谱与平原地区存在显著差异；高海拔地区现行临床治疗多参照平原地区经验，应引起相关部门的注意。

Objective To compare the differences of disease spectrum between patients with brain trauma injury （TBI） in the high altitude areas and those in the plain areas. Methods The front page information of medical records of local TBI patients admitted to military hospitals from 2001 to 2007 was extracted from the Chinese Trauma Database. Ten military hospitals from high altitude areas （high al- titude group） and 10 military hospitals with the same hospital level from plain areas （plain group） were selected and the patients in the two groups were compared for their differences in general condition and disease spectrum. Results High altitude group displayed a larger proportion of male patients （P 〈 0.01 ）, a lower age （ P 〈 0.01 ）, a smaller proportion of patients with Han nationality （ P 〈 0.01 ）, a smaller proportion of emergency patients （P 〈 0. 01 ）, a larger proportion of critically ill patients （P 〈 0.01 ）, a lower median of hospital days （ P 〈 0.01 ）, a lower operation rate （ P 〈 0.01 ）, as compared with the plain group. The injury of the patients with TBI in turn were intracranial organ injury （ excluding those with skull fracture）, open wound of head, neck, and trunk, skull fracture, injury of nerves and spinal cord. The orders of TBI disease spectrum of the high altitude and plain groups were the same, but the disease compositions of the two groups had significant difference （P 〈 0.01 ）. Conclusions Thereexist significant differences in demographics, admission status and disease spectrum of TBI patients in high altitude and plain areas. However, the current clinical treatments of TBI in high altitude areas are u- sually with reference to the experience in plain areas, which is worthy of paying attention by relevant de- partments.