颅脑损伤合并多发伤的救治原则及影响预后的因素分析

The effect of management in patients with traumatic brain injury associated with multiple traumas and the analysis of prognostic factors

目的探讨颅脑损伤合并其他部位多发伤的救治原则及影响预后的因素。方法回顾性分析天津医科大学总医院滨海医院神经外科2008年1月~2019年12月收治的颅脑损伤合并其他部位多发伤患者246例,总结其临床特点、诊疗情况、评估入院GCS及患者预后,并分析上述因素对患者死亡的影响。结果按GCS划分,轻型90例,中型52例,重型104例;合并颈椎损伤10例,胸腰椎损伤12例,胸部损伤48例,腹部损伤12例,骨盆骨折20例,肢体骨折120例,口腔颌面部损伤148例,失血性休克8例。出院时GOS:恢复良好76例,中度残疾80例,重度残疾50例,植物生存20例,死亡20例。入院GCS在不同预后组之间差异有统计学意义(P<0.05)。Logistic回归分析证实颅脑损伤合并颈椎损伤、胸部损伤和脾破裂的病死率高(P<0.05)。结论入院GCS、颈椎损伤、胸部损伤和脾破裂是影响颅脑损伤预后的重要因素;在积极处理颅脑损伤的同时及时治疗合并伤,是降低颅脑损伤合并其他部位多发伤病死率和致残率的关键。

Objective To investigate the management and prognosis of patients with traumatic brain injury(TBI)associated with multiple traumas in other organs.Methods 246 cases of traumatic brain injury associated with multiple traumas during 2008 and 2019 in department of Tianjin medical university general hospital were retrospectively analyzed.The clinical characteristics and managements of these patients were summarized,the GCS of admission and the prognosis of patients were evaluated.The factors related to the death in these patients were analyzed too.Results According to the GCS,the cases were divided into 3 different groups with 104 serious,52 moderate and 90 mild brain injuries respectively.The associated injuries in other organs were 10 cervical vertebrae injuries,12 thoracic and lumbar vertebrae injuries,48 thoracic injuries,12 abdominal injuries,20 pelvic fractures,120 limbs fractures,148 injuries in oromaxillo-facial region and 8 hemorrhagic shocks respectively.The Glasgow outcome score(GOS)in discharge was evaluated to reveal that 76 cases survived well,80 cases suffered from moderate disability,50 cases suffered from sever disability,20 cases sustained in vegetative state and 20 cases died.The GCS were significant different among the groups classified based on their different GOS(P<0.05).The Logistic regression analysis showed that TBI associated with cervical vertebrae injury,thoracic injury and splenic rupture could result in a higher mortality when compared with other types of TBI(P<0.05).Conclusion The important prognostic factors in brain injuries associated with other injuries are GCS on admission,cervical vertebrae injury,thoracic injury and spleen rupture respectively.It plays a key role in reducing the incidence of disability and the mortality of the TBI associated with multiple traumas in other organs that both brain and other organ injuries are treated in time.