重型颅脑损伤合并多器官功能障碍综合征的危险因素探讨

The discussion of risk factors of severe head injury with multiple organ dysfunction syndrome

目的：探讨重型颅脑损伤患者发生多器官功能障碍综合征（MODS）的相关危险因素，以指导临床工作，尽量减少MODS发生，降低病死率。方法回顾性分析149例重型颅脑损伤患者的临床资料，收集可能影响重型颅脑损伤患者发生MODS的危险因素，如性别、年龄、GCS评分、合并损伤、慢性基础疾病、感染等的详细资料，结合MODS的发生情况进行统计学分析。结果（1）与重型颅脑损伤发生MODS相关的危险因素为年龄、慢性基础疾病、入院时GCS评分、广泛脑实质损伤、合并大器官损伤、发生脑疝、并发感染、大量输血等（χ^2＝12．962、11．725、11．021、13．894、11．486、12．031、12．967、13．078，P＝0．023、0．025、0．027、0．017、0.023、0．018、0．021、0．019）。（2）MODS发生率与危险因素数目呈正相关（r＝0．528，P＝0．021）：存在3个危险因素的患者MODS发生率为26．7％，4个因素者发病率为39．5％，5个及以上者发病率达65．0％。（3） MODS患者病死率随着发生功能障碍器官的数目增加而显著升高：该组 MODS 患者中，2个器官者病死率17.4％，3个器官者46．7％，4个及以上者病死率87．5％，差异均有统计学意义（χ^2＝11．735、13．933、12．748， P＝0．028、0．019、0．025）。结论高龄、慢性基础疾病、GCS低、广泛脑实质损伤、合并大器官损伤、发生脑疝、并发感染、大量输血是颅脑损伤引起MODS独立危险因素。

Objective To investigate the discussion of risk factors of severe head injury with multiple organ dysfunction syndrome.Methods The clinical data of 149 cases with severe traumatic brain injury patients were retro-spectively analyzed,and the risk factors in patients with severe traumatic brain injury were collected,which may affect MODS,such as gender,age,GCS score,associated injuries,chronic underlying diseases,infections and other details, statistically analyzed were combined with incidence of MODS.Results （1 ）Univariate analysis results could be seen, age,chronic underlying diseases,admission GCS score,extensive brain parenchymal damage,merge large organ dam-age,brain herniation,concurrent infection,massive blood transfusion were risk factors of MODS severe traumatic brain injury（χ^2 =12.962,11.725,11.021,13.894,11.486,12.031,12.967,13.078,P=0.023,0.025,0.027,0.017, 0.023,0.018,0.021,0.019）.（2）MODS rate and the number of risk factors were positive correlation（r=0.528,P=0.021）.（3）With the increase of the number of mortality in patients with MODS organ dysfunction occurred signifi-cantly increased,MODS patients in this group,the two organs mortality was 17.4%,the three organs were 46.7%, four or more mortality was 87.5%（χ^2 =11.735,13.933,12.748,P=0.028,0.019,0.025）.Conclusion Age, chronic underlying diseases,GCS low,extensive parenchymal injury,combined injury,the occurrence of hernia,com-plicated by infection,massive blood transfusion were independent risk factors for brain injury,which should be payed attention.