重型颅脑损伤患者术中低血压对预后的影响

Association between intraoperative hypotension and outcome after severe traumatic brain injury

目的：分析重型颅脑损伤（severe traumatic brain injury,sTBI）患者术中低血压对预后的影响。方法：采用回顾性病例对照,统计患者性别,年龄,诊断,术前GCS评分,瞳孔,血压,甘露醇使用,术中麻醉诱导、过度通气、低血压、控制性升压、梯度降低颅压等12项指标作为自变量。术后1个月内死亡率,存活者ICU时间、出院时Glasgow结果分级（GOS）等预后指标为分组依据（因变量）。统计分析组间各自变量差异性,二元Logistic回归分析各具有差异性自变量是否为预后独立影响因素。结果：术后1月内死亡41例（23.2%）,134例存活超过1月,存活患者出院时GOS评分1~3分44例,4~5分90例。术中低血压与术后1个月死亡率及存活者ICU时间相关,与出院GOS评分无相关性。二元Logistic回归分析结果表明,在与其他影响因素,如瞳孔、术前GCS等共同分析时,术中低血压并未达到统计学差异的标准。结论：重型颅脑损伤患者术中低血压与死亡率有一定的相关性,但并非独立的影响因素,受到病情严重程度的影响,对术中低血压进行预防或可改善预后。

Objective： To analyse association between intraoperative hypotension and outcome after severe traumatic brain injury.Methods： A retrospective analysis was performed of severe TBI patients and recorded next indexes as independent variables： gender,age,diagnosis,preoperative GCS score,pupil,blood pressure,mannitol,intraoperative anesthesia induced hyperventilation,intraoperative hypotension,controlling boost gradient,gradient lower intracranial pressure.Prognostic indicators,including inhospital mortality and days during intensive care unit（ICU）,Glasgow outcome score（GOS） at discharge,were recorded as the dependent variables.The differences between each variable was analysed by the binary Logistic regression.Results： There were 41 cases（23.2%） died within one month after surgery,134 patients survived more than one month.The survival patients＇ discharge GOS score 1-3 were 44 cases,and 4-5 90 cases.Intraoperative hypotension was associated with postoperative 1 month mortality and survival ICU stay,but no with hospital discharges GOS.However,with other factors,such as the pupil,the preoperative GCS,intraoperative hypotension did not reach statistical difference,which indicated intraoperative hypotension was not independent relevant factors of postoperative 1 month mortality and ICU stay.Conclusions： Intraoperative hypotension was associated with the mortality in patients with severe traumatic brain injury,but not independent factor and influenced by the severity of the disease.To prevent intraoperative hypotension can improve the prognosis of patients with severe traumatic brain injury.