中、重型颅脑外伤患者血清酒精浓度对格拉斯哥评分和CT影像学表现的影响

Effect of blood alcohol concentration on Glasgow coma score and CT imaging findings in patients with moderate and severe traumatic brain injury

目的探讨中、重型颅脑外伤患者血清酒精浓度(BAC)对格拉斯哥评分(GCS)和CT影像学表现的影响。方法收集中、重型颅脑外伤患者112例,其中92例完成BAC测量,有序回归分析不同浓度组BAC对GCS评分的影响。根据Rotterdam CT评分判断脑外伤的严重性,分别在Rotterdam CT 1~3分组和4~6分组中通过相关性分析BAC对GCS评分的影响。结果 BAC测定的患者中91%有颅脑CT阳性发现,43%的患者BAC>0mg/dL。酒精阳性颅脑外伤患者的GCS评分低于酒精阴性患者(P<0.01)。其他外伤变量在酒精阳性和阴性患者间未见明显差异。剂量依赖模式下有序回归分析显示,逐渐增高的BAC是低GCS评分的一个重要独立预测因子(P<0.01);亚组分析显示在Rotterdam CT 1~3分组中BAC的增加与GCS评分呈相关性(P<0.01);而在Rotterdam CT 4~6组中未能发现两者的相关性(P=0.14~0.75)。结论酒精中毒可能是导致误判脑外伤患者意识的主要原因,但不能认为酒精中毒是影响中、重型颅脑外伤患者意识水平最重要的因素,脑外伤本身对意识的影响往往超过酒精的影响。

Objective To evaluate the influence of blood alcohol concentration(BAC)on Glasgow coma score(GCS)and CT imaging findings in patients with moderate and severe traumatic brain injury.Methods 112 patients with severe traumatic brain injury were collected,92 of them completed the BAC measurement,and the effect of different concentrations of BAC on the GCS was analyzed by ordinal regression analysis.According to the Rotterdam CT score to determine the severity of brain trauma,the effects of BAC on GCS were analyzed by correlation analysis in Rotterdam CT 1-3 point subgroup and 4-6 point subgroup respectively.Results 91%of the patients diagnosed by BAC had CT positive findings,and 43%had BAC>0 mg/dL.The GCS was lower in patients with alcohol-positive brain injury than that of patients with alcohol-negative(P<0.01).Other trauma variables showed no significant differences between alcohol positive and negative patients.Ordinal regression analysis showed that BAC was an important independent predictor of GCS(P<0.01);subgroup analysis showed that increasing in BAC was positively correlated to GCS in Rotterdam CT 1-3 point subgroup(P<0.01),while in Rotterdam CT 4-6 point group it failed to find the correlation(P=0.14-0.75).Conclusion Alcoholism may be the main reason leading to misjudgment of consciousness in traumatic brain injury patients,but alcoholism is not considered to be the most important factor affecting the level of consciousness in the moderate and severe traumatic brain injury patients,brain trauma itself has more heavy impact on consciousness than that of alcohol.