神经外科重型颅脑创伤急性期血压变异性对患者近期预后的影响研究

Research on the effect of term prognosis to blood pressure variability in acute phase of neurosurgical severe traumatic brain injury patients

目的探讨神经外科重型颅脑创伤(TBI)急性期血压变异性对患者近期预后的影响。方法选取110例重型TBI患者作为研究对象,根据格拉斯哥预后(GOS)评分分为预后良好组(n=53)和预后不良组(n=57),对两组患者术后3d内的血压变异性进行对比分析。结果预后良好组的平均年龄明显低于预后不良组,GCS评分、APACHEⅡ评分均明显高于预后不良组,P<0.05。预后良好组入院24h的收缩压标准差、舒张压标准差、收缩压变异系数均显著低于预后不良组,入院72h的收缩压标准差、舒张压标准差、收缩压变异系数、舒张压变异系数均显著低于预后不良组,P<0.05。APACHEⅡ评分是患者预后的保护因素,TBI程度、72h SD(SBP)是患者预后的危险因素。结论急性期血压变异性与重型TBI患者的预后密切相关,其影响患者预后的独立危险因素。

Objective To investigate the effect of acute phase early blood pressure variability to short- term prognosis in severe traumatic brain injury （ TBI ） patients in neurosurgery. Method 110 cases of severe traumatic brain injury patients as research subjects, according to Glasgow outcome （ COS ） score divided into good prognosis group （ n=53 ） and poor prognosis group （ n=57 ） .Compare and analysis of blood pressure variability 3days after surgery between two groups.Results The mean age of good prognosis group was significantly lower than the poor prognosis group, GCS score and APACHE II scores were significantly higher than poor prognosis group, P〈0.05. SBP standard deviation, DBP slandard deviation and SBP coefficients variation of good prognosis group hospitalized 24 hours were significantly lower than the poor prognosis group, SBP standard deviation, DBP standard deviation, SBP coefficients variation and DBP coefficients variation value of hospitalized 72 hours were significantly lower than the poor prognosis group, P〈O.OS.APACHEⅡ score was the protective factor for prognosis of patients, brain injury and 72 hours SD （ SBP ） were risk factors for prognosis. Conclusion Acute blood pressure variability is closely related with the prognosis of patients with severe traumatic brain injury, which is an independent risk factor for prognosis.