去骨瓣减压治疗sTBI早期结果与出院状态的影响因素分析

Factors associated with early outcomes and discharge status in patients with severe traumatic brain injury undergoing decompressive craniectomy

目的探讨影响重度创伤性颅脑损伤患者接受去骨瓣减压治疗早期结果和出院状态的独立预测因子并建立变量logistic回归方程。方法通过医院计算机电子数据库收集并回顾性分析2016年1月至2020年1月收治的114例重度颅脑损伤患者的临床资料,使用单变量、多逻辑回归和预后回归评分方程绘制受试者工作特征曲线,预测颅脑外伤后的早期结果和出院状态。结果年龄≤50岁(P=0.034)、无既往病史(P=0.003)、双侧瞳孔直径<4 mm(P=0.001)、入院时格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分>5分(P=0.004)和无气管切开(P=0.001)的接受去骨瓣减压治疗的重度创伤性颅脑损伤患者早期结果和出院状态较好;使用受试者工作特征曲线预测有利结果的概率,曲线下面积为79.0%,其中敏感度为66.7%,特异度为77.8%。结论年龄≤50岁、无既往病史、双侧瞳孔直径<4 mm、入院时GCS评分>5分和无气管切开可以作为评估接受去骨瓣减压治疗后重度创伤性颅脑损伤患者早期预后和出院状态的独立预测因子。

Objective To investigate the independent predictors affecting early outcomes and discharge status of patients with severe traumatic brain injury(sTBI)who underwent decompressive craniectomy and to establish variable logistic regression equations.Methods Clinical data of 114 patients with severe brain injury admitted from January 2016 to January 2020 were collected and retrospectively analyzed through a hospital computerized electronic database,and subject working characteristic curves were plotted using univariate,multiple logistic regression and prognostic regression scoring equations to predict early outcomes and discharge status after brain trauma.Results We found that patients with sTBI treated with decompressive craniectomy who were≤50 years of age(P=0.034),had no past medical history(P=0.003),had bilateral pupil diameters<4 mm(P=0.001),had a GCS score>5 scores on admission(P=0.004),and did not have a tracheotomy(P=0.001)had better early outcomes and discharge status.The probability of predicting a favorable outcome using the subject working characteristic curve had an area under the curve of 79.0%,including a sensitivity of 66.7%and a specificity of 77.8%.Conclusion Our preliminary findings suggest that≤50 years of age,no past medical history,bilateral pupil diameters<4 mm,GCS crore>5 scores can be used as independent predictors to assess early prognosis and discharge status in patients with severe traumatic brain injury after undergoing decompressive craniectomy therapy.