重型颅脑损伤的预后影响因素分析及临床救治策略

Analysis of prognostic determinants and clinical treatment strategy with severe trauma brain injury

目的研究影响重型颅脑损伤(STBI)预后的相关因素,探讨STBI的临床救治策略。方法回顾性分析2006年4月至2012年4月收治的142例STBI患者的临床资料,并在患者出院时进行预后分组,采用格拉斯哥结果评分(GOS)分级标准,Ⅰ～Ⅱ级患者视为预后不良,Ⅲ～Ⅳ级患者视为预后良好。将患者年龄、性别、格拉斯哥昏迷评分(GCS)、脑疝、CT环池形态、合并伤、休克、低氧血症、基础疾病及高血糖作为观察指标,采用χ2检验分析。结果 142例STBI患者预后不良68例(47.89%),其中死亡45例(31.69%);预后良好74例(52.11%)。影响患者预后的因素依次为脑疝、休克、CT环池形态、患者年龄、GCS及基础疾病(P<0.05)。结论脑疝、休克、CT环池形态、患者年龄、GCS及基础疾病能显著影响STBI患者的预后。针对患者个体的实际情况采取多学科协作治疗,是提高STBI患者救治的成功率、改善预后的关键。

Objective To explore the prognostic determinants and clinical treatment strategy in 142 patients with severe trauma brain injury（STBI）.Methods Retrospective analysis of clinical data of 142 patients with STBI in our department from April 2006 to April 2012.All the patients were divided into good prognosis group（Ⅲ～V grade）and poor prognosis group（I～Ⅱgrade）according to the GOS classification standard.Age,gender,GCS,encephalocele,morphotogy of the basal cisterns on CT scanning,associated injury,shock,hyoxemia,underlying disease and hyperglycemia were chosen as the observation index.Statistical analysis was performed with Pearson Chi-square Test.Results 52.11% of patients with good prognosis,47.89% of patients with poor prognosis and 31.69% of patients were dead.Age,GCS,encephalocele,morphotogy of the basal cisterns on CT scanning,associated injury,shock,underlying disease were the prognostic determinants of STBI（all results P0.05）.Conclusion Age,GCS,encephalocele,morphotogy of the basal cisterns on CT scanning,associated injury,shock,underlying disease can determine the prognosis of STBI.Multidisciplinary cooperation treatment depending on the patient′s conditions is the key of improving the outcomes of STBI.