颅脑创伤合并失血性休克的临床分析

Clinical analysis of hemorrhagic shock in patients with traumatic brain injury

目的探讨颅脑创伤合并失血性休克的发生率、处理方法及预后情况,提高临床预后及疗效。方法总结520例颅脑创伤患者的临床资料,回顾性分析合并失血性休克患者的临床表现、治疗及预后情况,总结TBI合并失血性休克的发生率及不同时间段的主要死亡原因。运用χ2检验等统计学方法,探讨性别、年龄、入院GCS评分、血压、脉搏、受伤至到达医院时间等相关危险因素。结果 520例颅脑创伤患者中有44例（8.46%,44/520）合并失血性休克,其中男性27例,女性17例;平均年龄（38.26±9.25）岁。交通事故是最常见的致伤原因（68.18%,30/44例）。格拉斯哥昏迷评分（GCS）3-5分16例,6-8分17例,8-12分11例。随访1个月25例（56.82%）患者死亡,其中24h内死亡10例,24h后15例。结论颅脑创伤合并失血性休克较为少见,但死亡率高。早期和后期主要死亡原因存在差异。早期（24h内）死亡原因为失血性休克,后期（72h后）主要为颅脑损伤,临床上应予以足够重视,早发现、早治疗,以争取获得最佳的治疗效果。

Objective To investigate the incidence,treatment and prognosis of traumatic brain injury（ TBI） combined with hemorrhagic shock,and improve the clinical prognosis and curative effect. Methods The clinical data of 520 patients with TBI were summarized. And we retrospectively analyzed the clinical manifestations,treatment and prognosis of patients with hemorrhagic shock. The incidence and major cause of death of TBI combined with hemorrhagic shock were summarized. Chi-square test was used to explore such risk factors as gender,age,GSC,blood pressure,pulse,etc.. Results Hemorrhagic shock occurred in 44 patients（ 8. 46%,44 /520）,including 27 males and 17 females,with the average age of（ 38. 26 ± 9. 25） years. Traffic accident was the most common cause of injury（ 68. 18%,30 /44）. Glasgow coma scale（ GCS） was 3-5 in 16 cases,6-8 in 17 cases and 8-12 in 11 cases. 25 patients（ 56. 82%） died during the follow-up of 1 month,among whom 10 patients died in 24 h and 15 patients after 24 h. Conclution TBI combined with hemorrhagic shock was rare,but the mortality was high. The major cause of death in the early stage（ 24h） was hemorrhagic shock,different from that of brain injury in the later stage（ 72h）. Attention should be paid clinically to early detection and early treatment to get the best therapeutic effect.