急性严重型颅脑损伤早期死亡的预测因素

Predictive factors for early mortality in acute severe traumatic brain injury

目的探讨急性严重型颅脑损伤患者早期死亡的预测因素。方法回顾性分析2017年6月—2019年12月雅安市人民医院神经外科收治的128例重度颅脑损伤患者,男性81例,女性47例;年龄14~76岁,平均47.5岁。道路交通伤68例,高空坠落伤18例,跌打伤22例,重物砸伤12例,殴打伤8例。观察患者的年龄、性别、入院时的瞳孔大小、光反射情况、入院时格拉斯哥昏迷评分(GCS)、低氧血症、低血压发生率、CT、颅脑损伤严重情况、活化部分凝血活酶时间(APTT)。以损伤后14d死亡为早期死亡,采用单因素分析和多因素Logistic回归分析影响患者早期死亡的预测因素。结果急性严重型颅脑损伤患者早期病死率为25%(32/128)。多因素Logistic回归分析显示急性重型颅脑损伤14d死亡最有效的预测因素是入院时低GCS(OR=0.33,95%CI0.002~0.501,P=0.014),双侧瞳孔对光无反射(OR=3.269,95%CI1.019~10.484,P=0.046),APTT延长(OR=2.448,95%CI1.438~4.166,P=0.001),中线移位>5mm(OR=5.186,95%CI1.843~14.593,P=0.002),颅内血肿量>30mL(OR=2.589,95%CI0.820~8.174,P=0.042)。结论入院时低GCS、瞳孔对光反射消失、APTT延长、中线移位>5mm、颅内血肿量>30mL可作为判断严重型颅脑损伤患者14d死亡的预测因素。

Objective To understand the predictive factors for early mortality of acute severe craniocerebral injury.Methods A retrospective study was performed on 128 patients with severe craniocerebral injury from Jun.2017 to Dec.2019.There were 81 males and 47 females,with an average age of 47.5 years(range,14-76 years).There were 68 cases of traffic accident injury,18 cases of high-falling injury,22 cases of falling injury,12 cases of object hitting injury and 8 cases of walloping injury.Gender,age,pupil size and light reflection at admission,Glasgow Coma Scale(GCS)at admission,presence of hypoxia and hypotension,computed tomography findings,and activated partial thromboplastin time(APTT)were evaluated.The mortality within 14 days was defined as early mortality.The predictors for early mortality in patients with acute severe craniocerebral injury were analyzed by multivariate Logistic regression.Results The early mortality rate of patients with acute severe head injury was 25%(32/128).Multivariate Logistic regression analysis showed that the most effective predictor of 14-day death from acute severe brain injury was GCS score at admission(OR=0.33,95%CI:0.002-0.501,P=0.014),absence of bilateral pupil reflection(OR=3.269,95%CI:1.019-10.484,P=0.046),prolonged APTT(OR=2.448,95%CI:1.438-4.166,P=0.001),midline shift>5mm(OR=5.186,95%CI:1.843-14.593,P=0.002),and intracranial hematoma volume>30mL(OR=2.589,95%CI:0.820-8.174,P=0.042).Conclusions Low GCS score at admission,absence of bilateral pupil reflection,prolonged APTT,midline brain shift>5mm and intracerebral hemorrhage>30mL may be helpful in predicting early mortality in patients with severe craniocerebral injury.