早期液体平衡与特重度颅脑外伤预后关系的回顾性研究

Analysis of the association of fluid balance and short-term outcome in Severe traumatic brain injury patients

目的明确高原单纯性脑外伤患者前三天液体负荷情况与预后的关系,并寻找导致患者不良预后的危险因素。方法回顾性分析山南市人民医院重症医学科2014年6月~2017年6月收住的118例单纯性颅脑外伤患者的相关生理学数据,并计算入住ICU后前三天的液体平衡情况,通过Logistic回归寻找导致不良预后的危险因素。结果生存组患者的前三天液体净平衡显著低于死亡组(964.28±752.83.vs.1885.64±1052.80毫升),但当液体净入量<530毫升及大于1882毫升时患者的死亡率均显著增加。Logistic回归显示液体负荷过重(P<0.001,OR=1.001;95%CI=1.001-1.002)、男性(P=0.025,OR=5.691;95%CI=1.238-26.153)及低血红蛋白(P=0.027,OR=0.958;95%CI=0.922-0.995)为预测患者死亡的独立危险因素。结论液体净平衡低或者过高均会增加高原单纯性特重度颅脑外伤患者的死亡率,同时男性及低血红蛋白血症均为患者死亡的独立危险因素。

Objective To observe the relationship between fluid balance and the outcome of isolated traumatic brain injury patients in ShanNan City Hospital. Methods We conducted a ret- rospective cohort study of 118 isolated severe TBI patients to associate the degree of fluid balance with clinical outcomes of TBI from June 2014 to June 2017. Fluid balance was continuously recor- ded for 3 days on patients admitted to intensive care unit （ICU）. Fluid balance was calculated as： Fluid intake （mL）-- fluid outputs （mL）/day × 3 and used to group patients in tertiles to study its effect on TBI outcome. The association between hemoglobin levels, age, fluid balance and mor- tality in hospital was tested with multivariable logistic regression analyses. Results The amount of fluid balance in survive group was significant less than the dead group （964. 28±752. 83. vs. 1885.64±1052.80ml）. Patients at the low （〈530 ml） and upper （〉1882ml） tertiles of fluid bal- ance were associated with poor outcomes. After adjustment for potential confounders, lower he- moglobin level（P=0. 027,OR：0. 958;95%0CI：0. 922-0. 995）,male（P=0. 025,OR：5. 691; 95%CI： 1. 238--26. 153） and positive fluid balance were independent predictor of in hospital mortality. Conclusion We found that fluid balance in low and upper tertiles were associated with poor short--term outcomes, lower hemoglobin level, male and positive fluid balance were inde- pendent predictor of in hospital mortality.