中重度颅脑外伤患者合并阵发性交感神经过度兴奋综合征的危险因素及对预后的影响

Risk factors of paroxysmal sympathetic hyperactivity after moderate or severe traumatic brain injury and impact on prognosis

目的分析在中重度颅脑外伤患者中与阵发性交感神经过度兴奋综合征(paroxysmal sympathetic hyperactivity,PSH)相关的危险因素,并分析PSH对此类患者预后的影响。方法选择在我院收治的中重度颅脑外伤患者为研究对象。收集所有患者的人口学信息和临床诊治信息。按照是否合并PSH将患者分为PSH组(n=27)和对照组(n=99),对相关变量进行回归分析,并分析PSH对中重度颅脑损伤预后[住院时间,住ICU时间,格拉斯哥预后评分(Glasgow Outcome Scale,GOS)]的相关性。结果共纳入患者126例(男性82例,女性44例),共有27例发生了PSH(21.4%)。与PSH发生相关的危险因素包括入院时收缩压>140 mmHg(1mmHg=0.133kPa)(OR=3.21,95%CI=1.31~7.87,P=0.011),GCS<8分(OR=4.34,95%CI=1.73~10.93,P=0.002),创伤后急诊CT提示存在脑挫裂伤(OR=4.29,95%CI=2.55~8.26,P<0.001),颅内出血量≥50 ml(OR=2.33,95%CI=1.42~5.13,P=0.003)以及后期出现脑积水(OR=3.57,95%CI=1.36~9.37,P=0.010)。而PSH又与住院时间>1个月(OR=5.21,95%CI=2.88~7.42,P=0.002)和GOS 1~3分有关(OR=1.75,95%CI=1.24~3.78,P=0.009)。结论 PSH是中重度颅脑外伤患者的一种常见并发症。PSH的发生与入院时收缩压较高、GCS较低、合并脑挫伤以及后期合并脑积水等因素密切相关,而合并PSH的患者住院时间更长,预后更差。

Objective To analyze the risk factors on paroxysmal sympathetic hyperactivity(PSH)after moderate or severe traumatic brain injury(TBI)and its impact on prognosis.Methods The subjects were patients with moderate or severe TBI treated in the hospital.The demographic information and clinical information were collected.The subjects were divided into two groups,PSH group(n =27)and control group(n =99)according to whether being diagnosed as PSH.The risk factors of PSH and its impact on prognosis of TBI were analyzed by logistic regression.Hospital stay time,ICU time,Glasgow Outcome Scale(GOS)were analyzed.Results In 126 subjects(male n =82;female n =44),27 subjects were diagnosed as PSH(21.4%).The potential risk factors of PSH included systolic blood pressure>140 mmHg at admission(OR =3.21,95%CI =1.31-7.87,P =0.011),GCS score<8(OR=4.34,95%CI =1.73-10.93,P =0.002),with cerebral contusion and laceration(OR =4.29,95%CI =2.55-8.26,P <0.001),the volume of intracranial hemorrhage≥50 ml(OR =2.33,95%CI =1.42-5.13,P =0.003)and with hydrocephalus(OR =3.57,95%CI=1.36-9.37,P =0.010).Moreover,PSH was associated with protracted hospital stays(OR =5.21,95%CI =2.88-7.42,P =0.002)and lower GOS(OR =1.75,95%CI =1.24-3.78,P =0.009).Conclusion PSH is a common complication in patients after moderate or severe TBI.The risk factors of PSH included higher systolic blood pressure >140 mmHg at admission,lower GCS score,with brain contusion and with hydrocephalus.The patients with PSH after moderate or severe TBI may stay more days in hospital and have bad prognosis.