高原地区重型颅脑损伤患者死亡因素分析

Risk factors related to mortality in high-altitude patients with severe traumatic brain injury

目的分析高原地区的重型颅脑损伤患者的死亡率和死亡危险因素。方法回顾性分析西藏军区总院2007年6月～2012年6月收治的367例高原地区重型颅脑损伤患者的病例资料,应用多因素logistic回归分析确定引起死亡的危险因素。结果患者入院3个月的总死亡率为22%(80/367)。患者受伤至入院时间(OR=1.805),入院时GCS评分(OR=1.991)、孔对光反射情况(OR=2.033)和头颅CT显示的中线移位程度(OR=1.717)为死亡的独立危险因素。患者性别、年龄和居住地海拔高度对于死亡率的影响未显示出统计学意义。结论本研究分析了高原地区重型颅脑损伤死亡的危险因素。受伤至入院时间较长、入院GCS评分低、双侧瞳孔散大或CT显示中线移位>10 mm的重型颅脑损伤患者死亡率高。这些发现有利于制定临床治疗方案,改善患者预后。

Objective This clinical study analyzed the mortality rates and analyzed the risk factors for mortality in high-altltude patients with severe traumatic brain injury. Methods We retrospectively reviewed the medical records of 367 high-altitude patients with severe traumatic brain injury at the General Hospital of Tibetan Military Region from June 2007 to June 2012. Multivariate Logistic regression analysis was used to evaluate the influence of clinical variables on mortality at 3 months after admission. Results The overall mortality was 22% （80/367） at 3 months. The time from trauma to admission （ OR = 1. 805 ）, initial Glasgow Coma Score （ OR = 1.991 ）, pupillary response （ OR = 2.033 ） and midline shift （ OR = 1.717 ） were independent risk factors for death, while no significant association was observed between the mortality rate and the gender, age or altitude of patients. Conclusions This study identified the risk factors for mortality in high-altitude patients with severe traumatic brain injury. The higher risk of death occurs in patients with longer intervals between trauma and admission, lower initial Glasgow Coma Scores, bilateral pupil dilatation and a Midline shift more than 10 mm on initial CT scan. The findings should help clinicians determine management criteria and improve survival.