老年创伤性颅脑损伤患者住院期间死亡的危险因素分析

Risk factors related to in-hospital mortality in elderly patients with traumatic brain injury

目的探讨老年创伤性颅脑损伤(TBI)患者住院期间死亡的危险因素。方法采用病例对照研究分析2012年1月至2018年10月首都医科大学附属潞河医院收治的709例老年颅脑损伤患者临床资料,其中男468例,女241例;年龄60∼97岁[(70.4±8.5)岁]。根据住院期间是否死亡将患者分为死亡组(82例)和生存组(627例)。记录两组患者性别、年龄、致伤原因(交通伤、摔伤、暴力打击伤、其他)、基础疾病史(高血压、脑梗死、糖尿病、冠心病)、入院时格拉斯哥昏迷评分(GCS)、手术方式(钻孔引流术、血肿清除术、去骨瓣减压术、颅内压监测术)、并发症(肺部感染、应激性溃疡、电解质紊乱、低蛋白血症、继发性癫痫)及住院时间等指标。采用单因素分析法分析上述指标与老年TBI患者住院期间死亡的相关性。采用多因素Logistic回归分析确定老年TBI患者住院期间死亡的独立危险因素。结果单因素分析结果显示,性别、致伤原因、高血压、脑梗死、糖尿病、入院时GCS、血肿清除术、去骨瓣减压术、颅内压监测术、肺部感染、应激性溃疡、住院时间与老年TBI患者住院期间死亡有一定的相关性(P<0.05或0.01),而年龄、冠心病史、钻孔引流术、电解质紊乱、低蛋白血症、继发性癫痫与老年TBI患者住院期间死亡不相关(P均>0.05)。多因素Logistic回归分析结果表明,摔伤(OR=0.28,95%CI 0.08∼0.96,P<0.05)、高血压(OR=0.29,95%CI 0.10∼0.84,P<0.05)、入院时GCS 9∼12分(OR=12.98,95%CI 4.70∼35.84,P<0.01)、入院时GCS 3∼8分(OR=33.67,95%CI 14.01~80.93,P<0.01)、住院时间<11 d(OR=0.06,95%CI 0.02~0.13,P<0.01)与老年TBI患者住院期间死亡显著相关。结论摔伤、高血压、入院时GCS≤12分、住院时间<11 d是老年TBI患者住院期间死亡的独立危险因素,而入院时GCS 3~8分患者的住院期间死亡风险比GCS≥9分患者更高,在评估老年TBI患者预后的影响因素时需考虑上述因素并给予积极处理。

Objective To investigate the risk factors of in-hospital mortality in elderly patients with traumatic brain injury(TBI).Methods A case control study was conducted on 709 elderly patients with TBI admitted to Luhe Hospital,Capital Medical University from January 2012 to October 2018,including 468 males and 241 females;aged 60-97 years[(70.4±8.5)years].Patients were divided into death group(n=82)and survival group(n=627)based on death or not during hospitalization.Data of the two groups were documented,including gender,age,causes of injury(traffic accident injury,fall injury,assault injury or others),history of comorbidities(hypertension,coronary heart disease,diabetes or coronary heart disease),Glasgow coma score(GCS)on admission,operation modalities(trepanation and drainage,hematoma evacuation,decompressive craniectomy or intracranial pressure monitoring),complications(pneumonia,stress ulcer,electrolyte imbalance,hypoproteinemia or secondary epilepsy)and length of hospitalization.Univariate analysis was used to analyze the correlation between the above factors and in-hospital mortality in elderly patients with TBI.Multivariate Logistic regression analysis was used to determine the independent risk factors for their in-hospital mortality.Results Univariate analysis showed that sex,causes of injury,hypertension,cerebral infarction,diabetes,GCS on admission,hematoma evacuation,decompressive craniectomy,intracranial pressure monitoring,pneumonia,stress ulcer and length of hospital stay were correlated with in-hospital mortality in elderly patients with TBI(P<0.05 or 0.01),while there was no correlation with age,history of coronary heart disease,trepanation and drainage,electrolyte imbalance,hypoproteinemia and secondary epilepsy(all P>0.05).Multivariate Logistic regression analysis showed that fall injury(OR=0.28,95%CI 0.08-0.96,P<0.05),hypertension(OR=0.29,95%CI 0.10-0.84,P<0.05),GCS of 9-12 points on admission(OR=12.98,95%CI 4.70-35.84,P<0.01),GCS of 3-8 points on admission(OR=33.67,95%CI 14.01-80.93,P<0.01)and length of hospital stay<11 days(OR=0.06,95%CI 0.02-0.13,P<0.01)were significantly associated with their in-hospital mortality.Conclusions Fall injury,hypertension,GCS≤12 points on admission and length of hospital stay<11 days are independent risk factors for in-hospital mortality in elderly patients with TBI,especially that patients with GCS of 3-8 points on admission have higher in-hospital modality than patients with GCS≥9 points,indicating the importance of above independent risk factors in evaluating outcome.