急性单发性创伤性颅脑损伤与离子紊乱的相关性研究

A Correlation Study between Acute Isolated Traumatic Brain Injury and Electrolyte Disturbance

目的分析急性单发性创伤性颅脑损伤后血钠、血钾、血氯、血镁、血钙离子的变化情况,并探究多重离子紊乱与颅脑损伤之间的关系。方法回顾性分析2012年7月—2015年6月中国医科大学附属第一医院神经外科收治的符合研究标准的患者158例,根据其入院格拉斯哥评分（Glasgow Coma Scale,GCS）判定颅脑损伤程度分为3组：重度损伤（GCS评分3-8分）78例,中度损伤（GCS评分9-14分）33例,轻度损伤（GCS评分15分）47例。分别收集患者急诊入院时即时血离子浓度。采用相应的统计学方法分析急性单发性创伤性颅脑外伤后离子降低的独立危险因素,不同组间离子浓度均数和不同离子类型的发生率分别同颅脑损伤严重程度的关系,以及不同组别中多重离子紊乱构成比的差异。结果损伤严重程度、CT提示中线位移、脑组织挫伤、蛛网膜下腔出血及颞叶和小脑损伤是颅脑损伤后离子降低的危险因素（OR〉1,P〈0.05）。血钠、血钾、血氯、和血镁浓度在不同颅脑损伤组间存在差异（rs〈0,P〈0.05）。各组间离子紊乱发生率存在显著性差异（P〈0.05）,其中对于多重离子紊乱,重度损伤组发生率与轻、中度损伤组存在明显差异（P〈0.05）。其中血钠、镁,血钠、氯、镁,血钠、氯以及血钠、钾、镁、氯同时降低这4类离子紊乱模式的发病率较高。结论颅脑损伤的程度与多重离子紊乱密切相关,多重离子紊乱既可以作为颅脑损伤严重程度的评价指标,又可加重颅脑损害。明确急性单发性创伤性颅脑损伤后离子变化情况对患者病情的诊断和治疗具有重要的指导意义。

Objective To analyze level changes of sodium,potassium,chloridion,magnesium and calcium ions in blood after acute isolated traumatic brain injury（ TBI） and to study relationship between multiple electrolyte disturbance and TBI. Methods Clinical data of 158 patients with acute isolated TBI fitted to study criteria during July 2012 and June 2015 was retrospectively analyzed,and the patients were divided into severe injury group（ n = 78,3-8 score of GCS）,moderate injury group（ n = 33,9-14 score of GCS） and mild injury group（ n = 47,15 score of GCS） according to Glasgow Coma Scale（ GCS） scores upon admission. The blood ionic concentrations upon admission were collected. Independent risk factors of ionic level reduction,relationships between mean value of serum ionic concentrations in groups and severity of acute isolated TBI,relationships between incidence rates of electrolyte disturbance in different ions and severity of acute isolated TBI and differences in constituent ratio of multiple electrolyte disturbance in groups after acute isolated TBI were analyzed using corresponding statistical methods. Results TBI severity,mid-line shift by CT examination,cerebral contusion,subarachnoid hemorrhage and temporal lobe and cerebella injury were independent risk factors of ionic level reduction after acute isolated TBI（ OR 1,P〈0. 05）. Serum concentration of sodium,potassium,chloridion and magnesium were significant differences among three groups（ rs 0,P〈0. 05）. There were significant differences in incidence rate of electrolyte disturbance among three groups（ P〈0. 05）. Incidence rate of multiple electrolyte disturbance was significant different between severe injury group and mild and moderate injury groups（ P〈0. 05）. Incidence rates of combined reduction levels of serum sodium and magnesium,serum sodium,chloridion and magnesium,serum sodium and chloridion and serum sodium,potassium,magnesium and chloridion were high. Conclusion Severity of traumatic brain injury is closely correlated with multiple electrolytes disturbance. The multiple electrolytes disturbance is not only the evaluation index for severity of traumatic brain injury,but also induces brain damage. The monitoring of serum electrolytes is vital for diagnosis and treatment of patients with acute isolated traumatic brain injury.