急性闭合性颅脑损伤进展性出血预测系统的初步建立与评价

Preliminary establishment and evaluation of progressive hemorrhage prediction system in acute closed craniocerebral injury

目的探讨急性闭合性颅脑损伤进展性出血预测系统的初步建立与评价。方法回顾性分析2012年6月~2020年6月陆军军医大学第一附属医院急救部收治的282例急性闭合性颅脑损伤患者的临床资料,按是否发生进展性出血性损伤分为进展组(n=62)和非进展组(n=220),采用卡方检验或t检验比较两组患者的年龄、性别、受伤部位、受伤机制、损伤类型(单一/多发颅脑损伤)、对光反射、GCS评分、多项生理指标和CT分级等资料,采用ROC曲线和多变量Logistic回归分析确定急性闭合性颅脑损伤后进展性出血的危险因素,根据回归系数β赋值后建立急性闭合性颅脑损伤进展性出血预测系统。结果年龄(≥56.5岁)、合并多种颅脑损伤、对光反射(迟钝)、GCS评分(9~12分)、白细胞(WBC,≥14.76×10^(9)/L)、凝血酶原时间(PT,≥11.25 s)、D-2聚体(D-dimer,≥10.51 mg/L)、活化部分凝血活酶时间(APTT,≥27.4 s)等8个指标为进展性出血损伤的独立危险因素(P<0.05),赋分后形成急性闭合性颅脑损伤进展性出血预测系统,并划分了低危、中危、高危和极高危四个危险分层,四个危险分层患者进展性出血发生率分别为2.4%、17.5%、46.4%、91.4%。结论建立急性闭合性颅脑损伤进展性出血的预测系统可以早期、方便、准确地进行伤情评估。

Objective To establish a preliminary prediction system for progressive hemorrhage in patients with acute closed craniocerebral injury.Methods The clinical data of 282 patients with acute closed craniocerebral injury treated in the Emergency Department of the First Affiliated Hospital of Army Medical University from 2012 to 2020 were analyzed retrospectively.The patients were divided into progressive group(n=62)and non-progressive group(n=220)according to the occurrence of progressive hemorrhagic injury.Chi-square test or t-test was used to compare the data of age,sex,site of injury,mechanism of injury,type of injury(Single/multiple craniocerebral injuries),light reflex,GCS score,multiple physiological indexes and CT grading of patients between the two groups.ROC curves and multivariate Logistic regression analysis were used to determine the risk factors of progressive hemorrhage after acute closed craniocerebral injury.The prediction system for progressive hemorrhage of acute closed craniocerebral injury was established according to the value of regression coefficientβ.Results Age(56.5 years or older),multiple craniocerebral injuries,light reflex(retardation),GCS score(9-12),white blood cell(14.76×10^(9)/L or more than),PT(11.25 s or more than),D-dimer(10.51 mg/L or more than),and APTT(27.4 s or more than)were independent risk factors for progressive hemorrhagic injury(P<0.05).These variables were given specific scores and prediction system was established,and the outcome was divided into four risk stratifications:low-risk,medium-risk,high-risk,and very high-risk.Conclusion The establishment of prediction system for progressive hemorrhage in acute closed craniocerebral injury can be used for early,convenient and accurate assessment of the injury.