重度颅脑损伤患者预后的相关因素分析

Prognostic factors of patients with severe traumatic brain injury

目的探讨重度颅脑损伤预后的相关因素。方法对80例特重度颅脑损伤的患者的临床资料进行回顾性分析，对影响颅脑损伤患者预后的相关指标进行探讨。结果存活组患者肌钙蛋白为（5．12±1．89）pg／L、肌酸激酶为（355．0±101．3）U／L、肌酸激酶同工酶为（79．5±23．4）U／L，均显著低于死亡组的（12．13±2．12）pg／L、（687．0±139．2）U／L、（180．2±53．5）U／L（t=12．95、8．96、12．45，均P〈0．05）。存活组患者C反应蛋白、血糖、血乳酸水平分别为（52．34±24．35）mg／L、（6．8±1．5）mmol／L、（7．2±1．3）mmol／L，显著低于死亡组的（67．12±23．31）mg／L、（11．4±4．2）mmol／L、（9．5±2．2）mmol／L（t=2．24、4．25、6．82，均P〈0．05）；存活组脑利钠肽水平为（23．4±3．5）μg/L，高于死亡组的（17．1±2．3）μg／L（t=7．21，P〈0．05）。存活组有27例存在钠失衡，死亡组有15例存在钠失衡，两组差异具有统计学意义（x2=13．64，P〈0．05）。结论C反应蛋白、脑利钠肽、血糖、血钠、血乳酸水平及肌钙蛋白、肌酸激酶、肌酸激酶同工酶浓度是影响重度颅脑损伤患者预后的重要因素，其水平越高，预后越差；脑钠肽水平越低，预后越差。

Objective To investigate the related factors of the prognosis of severe traumatic brain injury. Methods The clinical data of 80 patients with severe traumatic brain injury in our hospital were retrospectively ana- lyzed, to discuss the prognosis indicators of patients with traumatic brain injury. Results In survival group, the cardi- ac markers CTnI （5.12 ± 1.89） pg/L,CK （355.0 ± 101.3） U/L,CK-MB （79.. 5 ±23.4） U/L,were significantly low- er than （ 12.13 ± 2.12） pg/L, （ 687.0 ±139.2） U/L, （ 180.2 ± 53.5 ） U/L in the death group （ t = 12.95,8.96, 12.45, all P 〈 0.05 ）. The CRP, blood glucose, blood lactate levels of the survival group were （ 52.34 ± 24.35 ） mg/L, （6.8 ± 1.5 ） mmol/L, （7.2 ± 1.3 ） mmol/L, which were significantly lower than （ 67.12± 23.31 ） mg/L, （ 11.4 ± 4. 2） mmol/L, （9.5 ± 2.2） mmol/L of the death group （ t = 2.24,4.25,6.82, all P 〈 0.05 ）. The BNP level of the survival group was （23.4 ±3.5）μg/L, which was higher than （ 17. 1 ± 2.3 ） μg/L of the death group （P 〈 0.05）. 27 cases in survival group had sodium imbalance, 15 patients in death group had sodium imbalance, the difference was significant （ x2 = 13.64, P 〈 0.05 ）. Conclusion CRP, BNP, glucose, serum sodium, blood lactate levels and cTnI, CK, CK-MB concentrations are important factors affecting the prognosis of patients with severe traumatic brain injury. The higher of CRP, blood glucose, blood lactate and cTnI, CK, CK-MB levels, the worse of the prognosis ; the lower BNP level, the worse of the prognosis.