颅脑损伤合并多发伤的预后影响因素分析及急诊救治探讨

Related factors of traumatic brain injury combined with multiple injuries

目的 探讨影响颅脑损伤合并多发伤预后的有关指标以及综合治疗的意义. 方法 收集宜春市人民医院神经外科自2009年9月至2012年9月收治的123例颅脑损伤合并多发伤患者的临床资料,采用单因素和多因素Logistic回归分析方法,分析性别、年龄、收缩压、基础疾病、手术治疗、GCS评分、伤情严重程度（ISS）评分、伤后时间、血小板计数、血糖、颅脑损伤伴损伤部位、并发症等因素与患者生存预后的关系. 结果 Logistic回归分析结果显示,收缩压≤8.0 kPa、存在基础疾病、GCS评分≤8分、ISS评分≥25、伤后时间、胸腹部损伤和休克这7个变量是导致颅脑损伤合并多发伤患者预后差的独立危险因素. 结论 收缩压、基础疾病、GCS评分、ISS评分、伤后时间、胸腹部损伤和休克对评估颅脑损伤合并多发伤患者的预后有重要意义;重视颅脑损伤的治疗是颅脑损伤合并多发伤救治成功的关键.

Objective To analyze the clinical features of craniocerebral injury combined with multiple injuries,and investigate the significance of severity index and its comprehensive treatments.Methods The clinical data of 123 patients with traumatic brain injury combined with multiple injuries,admitted to our hospital from September 2009 to September 2012,were collected.The relationships between survival rate and such factors as gender,age,systolic pressure,basic disease,operation treatment,GCS scores,ISS scores,injury time,platelet count,blood glucose level,brain injury combined with other injuries and complications were determined by univariate analysis and multivariate logistic regression analysis with SPSSl3.0.Results Logistic regression analysis revealed that systolic pressure ≤8.0 kPa,basic disease,GCS scores≤8,ISS scores ≥25,injury time,thoracic and abdominal injury and shock were independent prognostic factors of traumatic brain injury combined with multiple injuries.Conclusion The multiple injuries have various causes：the systolic pressure ≤ 8.0 kPa,basic disease,GCS scores≤8,ISS scores≥25,injury time,thoracic and abdominal injury and shock can be used to predict the severity of injury and prognosis; paying attention to the treatment of head injury is the key of successful treatment.