新疆地区老年颅脑创伤患者的临床特征及其病死率影响因素分析

Clinical characteristics of elderly patients with traumatic brain injury and factors influencing their mortality in Xinjiang region

目的总结新疆地区老年颅脑创伤(TBI)住院患者的临床特征,并探讨影响患者病死率的危险因素。方法采用回顾性、多中心的研究方法,收集2021年1—12月新疆地区28家不同等级医院收治的老年(年龄≥65岁)TBI住院患者的临床资料,分析新疆地区老年TBI住院患者的临床特征。采用单因素分析和多因素logistic回归模型分析探讨可能影响患者病死率的因素。结果共纳入老年TBI患者538例,男女比例为2.02∶1.00;年龄[M(Q 1,Q 3)]为73(68,80)岁;平地跌倒(59.85%,322/538)是老年TBI的主要致伤原因,其次是交通事故伤(30.11%,162/538);大多数老年TBI患者为轻型损伤(72.11%,388/538);紧急行气管插管患者的占比为13.57%(73/538)。蛛网膜下腔出血(49.81%,268/538)是最多发的颅内损伤类型,45.35%(244/538)的患者合并有颅外损伤;14.68%(79/538)的患者存在中线偏移。入院收治于重症监护病房者占20.26%(109/538)。行保守治疗的患者占78.81%(424/538)。患者的病死率为6.69%(36/538)。单因素分析结果表明,入院时格拉斯哥昏迷评分、有无中线偏移、是否行紧急气管插管、收住地点、是否实施手术均与患者的病死率有关(均P<0.05)。多因素logistic回归模型分析结果显示,入院时格拉斯哥昏迷评分低(OR=6.99,95%CI:1.80~27.13)、存在中线偏移(OR=4.95,95%CI:1.97~12.46)、行紧急气管插管(OR=5.92,95%CI:2.12~16.53)、入院即收住重症监护病房(OR=6.41,95%CI:1.91~21.58)、实施手术(OR=4.62,95%CI:1.54~13.84)均为老年TBI患者死亡的独立危险因素(均P<0.05)。结论新疆地区老年TBI患者以男性为主,主要致伤原因为平地跌倒,总体预后较好。入院格拉斯哥昏迷评分偏低、发生中线偏移、行紧急气管插管、入院即收住重症监护病房、实施手术的患者死亡的风险更高。

ObjectiveTo summarize the clinical characteristics of elderly patients hospitalized with traumatic brain injury(TBI)in Xinjiang,and to explore the risk factors affecting patients′mortality.MethodsA retrospective,multicenter study was conducted on the data of the clinical characteristics of elderly(≥65 years old)TBI inpatients in 28 hospitals of different levels in Xinjiang region from January 2021 to December 2021.We analyzed the clinical characteristics of elderly TBI inpatients in Xinjiang.Univariate analysis and multifactorial logistic regression analysis were used to explore the factors that might affect the mortality of patients.ResultsA total of 538 elderly TBI patients were included.The ratio of male to female was 2.02∶1.00 and the median age[M(Q 1,Q 3)]was 73(68,80)years old.Falling(59.85%,322/538)was the leading cause of injury in elder adults with TBI,followed by traffic injuries(30.11%,162/538).Subarachnoid hemorrhage(49.81%,268/538)was the most frequent type of intracranial injury,and 45.35%(244/538)of the patients had a combined extracranial injury.14.68%(79/538)of the patients exhibited midline shift.20.26%(109/538)of the patients were admitted to the intensive care unit.Conservative treatment was given to 78.81%(424/538)of the patients.The patient′mortality rate was 6.69%(36/538).The results of univariate analysis showed that Glasgow Coma Score,the occurrence of midline shift,the occurrence of emergency tracheal intubation,place of admission,and whether or not surgery was performed were associated with the patient′mortality(all P<0.05).The results of multifactorial logistic analysis showed that low Glasgow Coma Score on admission(OR=6.99,95%CI:1.80-27.13),midline shift(OR=4.95,95%CI:1.97-12.46),emergency endotracheal intubation(OR=5.92,95%CI:2.12-16.53),and being admitted to the intensive care unit(OR=6.41,95%CI:1.91-21.58),and performing surgery(OR=4.62,95%CI:1.54-13.84)were all independent risk factors for death in elderly TBI patients(all P<0.05).ConclusionsElderly TBI patients in Xinjiang region are predominantly males,the main cause of injury is falling on the ground,and the overall prognosis is good.Patients with a low Glasgow Coma Score on admission,midline shift,emergency tracheal intubation,immediate admission to the intensive care unit,and surgery seem to be at higher risk of death.