严重创伤性颅脑损伤患者发生急性呼吸窘迫综合征的危险因素及预后分析

Risk factors and the prognosis of acute respiratory distress syndrome in the patients with severe traumatic brain injury

目的探讨严重创伤性颅脑损伤(sTBI)后急性呼吸窘迫综合征(ARDS)发生的危险因素并对患者预后进行分析。方法回顾性纳入2018年1月至2024年1月解放军东部战区总医院单纯性sTBI患者共328例,根据受伤后7 d内是否出现ARDS分为ARDS组(107例)和非ARDS组(221例);对患者一般信息(年龄、性别、吸烟情况、糖尿病、高血压等)、创伤程度[头颅简明损伤评分(AIS)、格拉斯哥昏迷评分(GCS)、输血及血小板输注情况]以及相关血生化指标[包括碱剩余(BE)、血肌酐(SCr)、尿素氮、降钙素原(PCT)等]采用单因素和多因素法评估sTBI发生ARDS的危险因素,绘制风险预测模型,并对患者预后进行分析。结果几乎所有sTBI患者出现ARDS的时间都是在损伤后7 d内,年龄>55岁、血糖、PCT水平、休克、输注血小板>10 U、GCS评分、血清BE<-6 mmol/L、SCr及血尿素氮组间比较差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄>55岁、GCS低评分(<8分)、休克、输注血小板>10 U、血PCT≥10.01μg/L是sTBI后ARDS发生的危险因素,ARDS组患者病死率(61.5%vs.26.4%)、平均住院时间(d:14.8±3.4 vs.11.4±3.6)、机械通气持续时间(d:11.6±2.8 vs.7.8±2.1)等均高于未出现ARDS组(P<0.05)。结论GCS低评分(<8分)、年龄>55岁、输注血小板>10 U、休克、血PCT≥10.01μg/L是sTBI后ARDS发生的独立危险因素。对存在高危因素患者应早期识别、及时联合干预,有可能降低并发症的发生,改善患者预后。

Objective To investigate the risk factors of acute respiratory distress syndrome(ARDS)after severe traumatic brain injury(sTBI)and to analyze the prognosis of patients.Methods A total of 328 patients with simple sTBI treated in the General Hospital of the Eastern Theater Command of Chinese People′s Liberation Army from January 2018 to January 2024 were retrospectively included,and were divided into ARDS group(107 cases)and non-ARDS group(221 cases)according to whether ARDS occurred within 7 d after injury.General information of the patients(age,gender,smoking,diabetes,hypertension,etc.),the degree of trauma[head abbreviated injury scale(AIS),Glasgow coma scale(GCS),blood transfusion and platelet transfusion]and related blood biochemical indicators[including base excess(BE),serum creatinine(SCr),blood urea nitrogen,procalcitonin(PCT)]were used to evaluate the risk factors of ARDS in sTBI by univariate and multivariate method.A risk prediction model curve was drawn,and the prognostic analysis was performed.Results Almost all sTBI patients experienced ARDS within 7 d of injury,the age>55,blood glucose levels,serum PCT levels,shock,platelet transfusion>10 U,GCS score,serum BE<-6 mmol/L,SCr levels and blood urea nitrogen levels showed statistical significance between two groups(P<0.05).Multivariate Logistic regression analysis results showed that the age>55,low GCS score(<8 scores),shock,platelet infusion>10 U and serum PCT level≥10.01μg/L were risk factors for ARDS after sTBI.The mortality rate(61.5%vs.26.4%),average length of hospital stay(d:14.8±3.4 vs.11.4±3.6),and duration of mechanical ventilation(d:11.6±2.8 vs.7.8±2.1)in ARDS group were higher than those in the non-ARDS(P<0.05).Conclusions Low GCS score(<8 scores),age>55,platelet infusion>10 U,shock,and serum PCT levels≥10.01μg/L are independent risk factors for the occurrence of ARDS after sTBI.Early identification and timely joint intervention may reduce the incidence of complications in sTBI patients with high-risk factors.