影响重型颅脑损伤患者预后的临床因素分析

Multiple clinical factor analysis of prognosis in patients with severe traumatic brain injury

目的探讨影响重型颅脑损伤患者预后的临床因素。方法回顾性分析南方医科大学附属花都医院神经外科自2013年5月至2015年7月收治的213例重型颅脑损伤患者的临床资料，Cox比例风险回归模型分析患者预后的影响因素。结果患者随访1-90 d，死亡34例（15.96%），其中死亡时间为入院后1-10 d的患者23例（67.6%），11-20 d的9例（4.2%），20-30 d的2例（0.9%），死因均与重型颅脑损伤相关。Cox比例风险回归模型分析显示年龄、入院mGCS评分、改良CT图像评分、脑疝是影响患者预后的独立危险因素（P〈0.05）。结论年龄、入院mGCS评分、改良CT图像评分、脑疝是影响重型颅脑损伤患者预后的重要因素。

Objective To investigate the potential clinical prognostic factors of severe traumatic brain injury. Methods Two hundred and thirteen severe traumatic brain injury patients, admitted to our hospital from May 2013 to July 2015, were chosen in our study. Their clinical data were retrospectively analyzed; prognostic factors, including age, gender, mGCS scores （movement GCS scores）, improved CT scores, brain hernia, volume of intracranial hematoma, range of cerebral contusion and laceration, and location of intracranial hematoma, were estimated using Chi square test, and after the Chi square test, the factors enjoying statistical significance were analyzed by COX proportional hazards regression model. Results The mortality rate was 15.9% （34/213）. Death occurred within 30 days of admission, and death mostly occurred within 10 days of admission （1-10 d： 23 patients; 11-20 d： 9 patients; 20-30 d： 2 patients）. Cox proportional hazards regression analysis indicated that age, GCS scores （movement GCS scores）, improved CT scores, and brain hernia were the prognostic risk factors in patients with severe traumatic brain injury, while gender, volume of intracranial hematoma, range of cerebral contusion and laceration, and location of intracranial hematoma were not. Conclusion Age, mGCS scores （movement GCS scores）, improved CT scores, and brain hernia dare important factors affecting the prognosis of patients with severe traumatic brain injury.