炎症反应综合征对急性重型颅脑损伤患者结局的影响

Clinical study of systemic inflammatory response syndrome after acute and severe trauma brain injure:a retrospective case-control study

目的研究急性重型颅脑损伤与发生全身炎症反应综合征(SIRS)的关系及对预后的影响。方法研究人群来源于我院2009年6月～2012年6月符合急性重型颅脑损伤住院患者,采用回顾性病例对照研究,先调查SIRS在本组患者的发病率,继之以单因素和多因素统计分析,了解SIRS与临床结局的关联。统计模型采用Pearson分析模型行单因素分析,Logistic回归模型行多因素分析。结果共纳入118例符合标准的患者,建立研究数据集。数据经清理和标准化后进行分析。发现:①急性重型颅脑损伤后SIRS的发生率为68.6%,与性别、年龄无关,与入院时GCS评分、有无脑干伤、入院时ISS≥26分有关,各组间比较P<0.05;②将出院时GOS作为结局指标分为死亡组(GOS 1分)、预后不良组(GOS 2～3分)、预后良好组(4～5分),统计发现发生SIRS后将增加病死率和不良预后率,3组间比较P<0.05;③为消除混杂偏倚,按照GOS对入院临床指标进行分层分析,显示入院时GCS评分、ISS≥26分、有无脑干伤交互效应明显,多元回归ISS≥26分对SIRS效应值OR值3.73(P=0.032),有显著差异。结论急性重型颅脑损伤易发生SIRS,与病情轻重有关;SIRS的出现将影响预后;ISS≥26分时,易发SIRS且SIRS将成为影响预后的独立因素。

Objective To study the relationship between the systemic inflammatory response syndrome（SIRS）and acute and severe traumatic brain injure（TBI）,and to discuss the prognosis of SIRS patients.Methods 118 patients with acute and severe TBI were analyzed retrospectively which came from our hospital in 2009/6/1～2012/6/1.We used retrospective case-control study design for the study,and Pearson x2 and Logistic regression were adopted.According to the temperature,heart rates,respiratory rates and count of white blood cell,the relationship between severity of disease and SIRS,SIRS and prognosis were studied.Results ①It would 68.6% chance for getting SIRS after acute and severe TBI,and it hadn＇t correlation for sex,age,GCS in the first day of hospital admission,brain stem injury and ISS score（P0.05）.② We cut GOS into 3 groups（death,GOS=1;poor prognosis,GOS = 2～3;well prognosis,GOS = 4～5）,then SIRS could increase death and poor prognosis（P0.05）.③ We adopt stratified analysis by GOS to eliminate confounding bias.GCS,ISS,brain stem injury have confounding bias with GOS.Logistic regression would be applied,and result was ISS≥26,OR=3.73（P=0.032）.Conclusion Acute and severe TBI was usually complicated by SIRS,SIRS had relationship to severity of disease,the activation of the SIRS following acute and severe TBI did not bode well and produced clinical worsening and a poor outcome,and SIRS was the independent factor for GOS.