弥漫性轴索损伤102例预后及相关因素分析

Prognosis and analysis of associated factors in 102 patients with diffuse axonal injury

目的探讨弥漫性轴索损伤(DAI)患者预后并分析相关因素。方法选取2016年1月—2018年1月我院急诊外科收住院的DAI患者102例,根据患者受伤后6个月的存活情况分为生存组(n=70)和死亡组(n=32),DAI后6个月时将其中67例存活患者根据细化型格拉斯哥预后评分(GOS-E)分为依赖组(n=8)和独立组(n=59)。利用患者入院时和住院过程中的相关临床资料来分别分析DAI患者死亡和依赖相关的因素,采用新的损伤严重程度评分(NISS)和Gennarelli临床分级评估患者脑损伤的严重程度,应用χ~2检验及Fisher精确概率法分析患者入院和住院期间相关因素的比例高低。结果 102例患者入院时损伤严重度评分(NISS)为(46.83±10.69)分,63.7%(65/102)的患者Gennarelli临床分级为轻中度DAI,36.3%(37/102)为重度。与重度患者相比,轻中度DAI患者的存活率较高,生活依赖率较低(P<0.05)。入院时死亡组患者发生血糖异常、血氧饱和度(SpO_2)异常和瞳孔异常比例高于生存组(P<0.05)。住院期间死亡组患者发生其他并发症、脑出血(ICH)、血压异常比例高于生存组,DAI早期CT征象出现比例低于生存组(P<0.05),而依赖组ICU住院、感染、持续镇静药物使用、其他并发症、ICH高于独立组(P<0.05)。结论(1)DAI患者损伤越重,死亡率越高,依赖性越高;(2)死亡组在入院时血糖异常、SpO_2异常和瞳孔异常的发生比例高;在住院期间血压异常、DAI早期CT征象、ICH、其他并发症的发生比例高。(3)依赖组在住院期间ICU住院、感染、持续镇静药物使用、其他并发症和ICH的发生比例高。

Objective To investigate the prognosis of 102 patients with diffuse axonal injury(DAI)and analyze the related factors.Methods A total of 102 DAI patients hospitalized in our hospital from January 2016 to January 2018 were divided into survival group(n=70)and death group(n=32)according to the 6-month survival after injury.The extended Glasgow outcome score(GOS-E)was used to describe the prognosis of patients who were survival at 6 months after injury,and these patients were subdivided into dependent group(n=8)and independent group(n=59).The chi-square test and Fisher's exact method were used to determine the factors associated with prognosis including mortality and dependence of patients.Results The new injury severity score(NISS)was(46.83±10.69)for 102 patients at admission.The 63.7%of these DAI patients(65/102)were classified as mild or moderate DAI,and 36.3%of patients(37/102)were severe DAI.Patients with mild to moderate DAI showed higher survival rate and lower dependence rate on life than patients with severe DAI(P<0.05).The incidence of abnormal blood glucose,abnormal SpO2 and pupillary abnormality were higher in the death group at admission than those in the survival group(P<0.05).During hospitalization,the incidence of other complications,cerebral hemorrhage(ICH)and abnormal blood pressure were higher in the death group compared with those of survival group,but the proportion of early DAI signs on CT was lower in death group(P<0.05).In the dependent group,ICU hospitalization,infection,continued sedative drug use,other complications and ICH were higher than those in the independent group(P<0.05).Conclusion(1)The more severe the injury of DAI patients,the higher the mortality rate and dependence.(2)There are high incidence of abnormal blood glucose,SpO2 abnormality and pupillary abnormality at admission and high incidence of blood pressure abnormalities,early DAI signs on CT,ICH,and other complications during hospitalization in patients in the death group.(3)Patients in the dependent group show a high proportion of ICU hospitalization,infection,continued sedative drug use,other complications and ICH during hospitalization.