FOXO1 reshapes neutrophils to aggravate acute brain damage and promote late depression after traumatic brain injury

Background:Neutrophils are traditionally viewed as first responders but have a short onset of action in response to traumatic brain injury(TBI).However,the heterogeneity,multifunctionality,and time-dependent modulation of brain damage and outcome mediated by neutrophils after TBI remain poorly understood.Methods:Using the combined single-cell transcriptomics,metabolomics,and proteomics analysis from TBI patients and the TBI mouse model,we investigate a novel neutrophil phenotype and its associated effects on TBI outcome by neurological deficit scoring and behavioral tests.We also characterized the underlying mechanisms both invitro and invivo through molecular simulations,signaling detections,gene expression regulation assessments[including dual-luciferase reporter and chromatin immunoprecipitation(ChIP)assays],primary cultures or co-cultures of neutrophils and oligodendrocytes,intracellular iron,and lipid hydroperoxide concentration measurements,as well as forkhead box protein O1(FOXO1)conditional knockout mice.Results:We identified that high expression of the FOXO1 protein was induced in neutrophils after TBI both in TBI patients and the TBI mouse model.Infiltration of these FOXO1high neutrophils in the brain was detected not only in the acute phase but also in the chronic phase post-TBI,aggravating acute brain inflammatory damage and promoting late TBI-induced depression.In the acute stage,FOXO1 upregulated cytoplasmic Versican(VCAN)to interact with the apoptosis regulator B-cell lymphoma-2(BCL-2)-associated X protein(BAX),suppressing the mitochondrial translocation of BAX,which mediated the antiapoptotic effect companied with enhancing interleukin-6(IL-6)production of FOXO1high neutrophils.In the chronic stage,the“FOXO1-transferrin receptor(TFRC)”mechanism contributes to FOXO1high neutrophil ferroptosis,disturbing the iron homeostasis of oligodendrocytes and inducing a reduction in myelin basic protein,which contributes to the progression of late depression after TBI.Conclusions:FOXO1high neutrophils represent a novel neutrophil phenotype that emerges in response to acute and chronic TBI,which provides insight into the heterogeneity,reprogramming activity,and versatility of neutrophils in TBI.

Acute drivers of neuroinflammation in traumatic brain injury

Neuroinflammation is initiated as a result of traumatic brain injury and can exacerbate evolving tissue pathology.Immune cells respond to acute signals from damaged cells,initiate neuroinflammation,and drive the pathological consequences over time.Importantly,the mechanism(s)of injury,the location of the immune cells within the brain,and the animal species all contribute to immune cell behavior following traumatic brain injury.Understanding the signals that initiate neuroinflammation and the context in which they appear may be critical for understanding immune cell contributions to pathology and regeneration.Within this paper,we review a number of factors that could affect immune cell behavior acutely following traumatic brain injury.

Acute kidney injury in traumatic brain injury intensive care unit patients

BACKGROUND The exact definition of Acute kidney injury(AKI)for patients with traumatic brain injury(TBI)is unknown.AIM To compare the power of the“Risk,Injury,Failure,Loss of kidney function,and End-stage kidney disease”(RIFLE),Acute Kidney Injury Network(AKIN),Creatinine kinetics(CK),and Kidney Disease Improving Global Outcomes(KDIGO)to determine AKI incidence/stage and their association with the inhospital mortality rate of patients with TBI.METHODS This retrospective study collected the data of patients admitted to the intensive care unit for neurotrauma from 2001 to 2012,and 1648 patients were included.The subjects in this study were assessed for the presence and stage of AKI using RIFLE,AKIN,CK,and KDIGO.In addition,the propensity score matching method was used.RESULTS Among the 1648 patients,291(17.7%)had AKI,according to KDIGO.The highest incidence of AKI was found by KDIGO(17.7%),followed by AKIN(17.1%),RIFLE(12.7%),and CK(11.5%)(P=0.97).Concordance between KDIGO and RIFLE/AKIN/CK was 99.3%/99.1%/99.3%for stage 0,36.0%/91.5%/44.5%for stage 1,35.9%/90.6%/11.3%for stage 2,and 47.4%/89.5%/36.8%for stage 3.The in-hospital mortality rates increased with the AKI stage in all four definitions.The severity of AKI by all definitions and stages was not associated with inhospital mortality in the multivariable analyses(all P>0.05).CONCLUSION Differences are seen in AKI diagnosis and in-hospital mortality among the four AKI definitions or stages.This study revealed that KDIGO is the best method to define AKI in patients with TBI.

Dynamic changes in growth factor levels over a 7-day period predict the functional outcomes of traumatic brain injury

Traumatic brain injury（TBI） can result in poor functional outcomes and death, and overall outcomes are varied. Growth factors, such as angiopoietin-1（Ang-1）, vascular endothelial growth factor（VEGF）, and granulocyte-colony stimulating factor（G-CSF）, play important roles in the neurological functions. This study investigated the relationship between serum growth factor levels and long-term outcomes after TBI. Blood samples from 55 patients were collected at 1, 3 and 7 days after TBI. Blood samples from 39 healthy controls were collected as a control group. Serum Ang-1, G-CSF, and VEGF levels were measured using ELISA. Patients were monitored for 3 months using the Glasgow Outcome Scale-Extended（GOSE）. Patients having a GOSE score of 〉 5 at 3 months were categorized as a good outcome, and patients with a GOSE score of 1-5 were categorized as a bad outcome. Our data demonstrated that TBI patients showed significantly increased growth factor levels within 7 days compared with healthy controls. Serum levels of Ang-1 at 1 and 7 days and G-CSF levels at 7 days were significantly higher in patients with good outcomes than in patients with poor outcomes. VEGF levels at 7 days were remarkably higher in patients with poor outcomes than in patients with good outcomes. Receiver operating characteristic analysis showed that the best cut-off points of serum growth factor levels at 7 days to predict functional outcome were 1,333 pg/mL for VEGF, 447.2 pg/mL for G-CSF, and 90.6 ng/mL for Ang-1. These data suggest that patients with elevated levels of serum Ang-1, G-CSF, and decreased VEGF levels had a better prognosis in the acute phase of TBI（within 7 days）. This study was registered with the Chinese Clinical Trial Registry（registration number： ChiCTR1800018251） on September 7, 2018.

Hydroxyethylstarch revisited for acute brain injury treatment

Infusion of the colloid hydroxyethylstarch has been used for volume substitution to maintain hemodynamics and microcirculation after e.g., severe blood loss.In the last decade it was revealed that hydroxyethylstarch can aggravate acute kidney injury, especially in septic patients.Because of the serious risk for critically ill patients, the administration of hydroxyethylstarch was restricted for clinical use.Animal studies and recently published in vitro experiments showed that hydroxyethylstarch might exert protective effects on the blood-brain barrier.Since the prevention of blood-brain barrier disruption was shown to go along with the reduction of brain damage after several kinds of insults, we revisit the topic hydroxyethylstarch and discuss a possible niche for the application of hydroxyethylstarch in acute brain injury treatment.

Effect of Early Controlled Hypotension on Patients with Traumatic Brain Injury

Objective:To investigate the clinical effect of early controlled hypotensive therapy in patients with traumatic braininjury(TBI).Methods:68 patients with acute 1Bl in our hospital were selected for this investigation.They were evenly divided into a control group and an observation group according to the difference of blood pressure and basic level,whose lesion area after treatment,postoperative intracranial pressure after 2 d and 7d,and Gcs score of prognostic quality before and after treatment were made comparison.Results:The post-treatment lesion area of the observation group was lower than that in the control group(P<0.05);the postoperative intracranial pressure after 2d and 7d of the control group was better than the observation group(P<0.05),and the same with GCS score,which has statistical sigmificance(P< 0.05).Conclusion:Early controlled hypotensive therapy has a significant clinical effect on patients with brain trauuma,it can reduce the lesion area after treatment and postoperative intracranial pressure as well.

Electroacupuncture in Treatment of Acute Gastrointestinal Injury in Patients with Severe Traumatic Brain Injury:A Multicenter Randomized Controlled Trial

Objective: To evaluate whether electroacupuncture(EA) would improve gastrointestinal function and clinical prognosis in patients with severe traumatic brain injury(TBI) complicocted by acute gastrointestinal injury(AGI). Methods: This multicenter, single-blind trial included patients with TBI and AGI admitted to 5Chinese hospitals from September 2018 to December 2019. A total of 500 patients were randomized to the control or acupuncture groups using a random number table, 250 cases in each group. Patients in the control group received conventional treatment, including mannitol, nutritional support, epilepsy and infection prevention, and maintenance of water, electrolytes, and acid-base balance. While patients in the acupuncture group received EA intervention at bilateral Zusanli(ST 36), Shangjuxu(ST 37), Xiajuxu(ST 39), Tianshu(ST 25), and Zhongwan(RN 12) acupoints in addition to the conventional treatment, 30 min per time, twice daily,for 7 d. The primary endpoint was 28-d mortality. The secondary endpoints were serum levels of D-lactic acid(D-lac), diamine oxidase(DAO), lipopolysaccharide(LPS), motilin(MTL) and gastrin(GAS), intra-abdominal pressure(IAP), bowel sounds, abdominal circumference, AGI grade, scores of gastrointestinal failure(GIF),Glasgow Coma Scale(GCS), Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ), Sequential Organ Failure Assessment(SOFA), and Multiple Organ Dysfunction Syndrome(MODS), mechanical ventilation time,intense care unit(ICU) stay, and the incidence of hospital-acquired pneumonia. Results: The 28-d mortality in the acupuncture group was lower than that in the control group(22.80% vs. 33.20%, P<0.05). Compared with the control group, the acupuncture group at 7 d showed lower GIF, APACHE Ⅱ, SOFA, MODS scores, D-lac,DAO, LPS, IAP, and abdominal circumference and higher GCS score, MTL, GAS, and bowel sound frequency(all P<0.05). In addition, the above indices showed simillar changes at 7 d compared with days 1 and 3 in the EA group(all P<0.05). Conclusion: Early EA can improve gastrointestinal function and clinical prognosis in patients with severe TBI complicated by AGI.(Registration No. ChiCTR2000032276)

Management and Outcome of Acute Subdural Hematoma in Gabriel TouréHospital

Background: Traumatic Brain Injury (TBI) is a major health problem worldwide. It is the main cause of trauma mortality. Acute subdural hematoma (ASDH) has a reputation for being the most serious of all posttraumatic head injuries. Its frequency is estimated to be 1% to 5% of all head injuries and 22% of severe head injuries. The aim of this study was to assess the epidemiological, clinical and prognosis aspects of ASDH in our department. Material and Methods: This prospective study, from January to December 2019, included 57 patients admitted to the Gabriel Touré Teaching Hospital for ASDH. Patients underwent detailed clinical and radiological evaluation and ASDH was diagnosed by non-contrast computed tomography (CT) scan. Functional outcome was evaluated 6 months after injury by Glasgow Outcome Scale. Results: During the study period, 662 patients were admitted for TBI including 57 (8.61%) cases of ASDH. The mean age was 34 years with extremes of 2 and 77 years. There was a male predominance with 52 (91.2%). The main cause of trauma was motor vehicle accidents in 38 (66.6%) patients. According to the Glasgow coma scale (GCS), 33 (57.9%) patients were classified mild (Table 2). The thickness of the hematoma was more than 1 cm in 13 (22.8%) patients and less than 1 cm in 44 (77%) patients. Surgical treatment was performed in 13 (22.8%) patients. The outcome was favorable in 30 (52.6%) patients and the mortality rate was 33.3%. Conclusion: ASDH remains a difficult challenge because of the high mortality. The mortality rate remains high particularly in patient with poor GCS score at admission.

Haemodynamic management in brain death donors:Influence of aetiology of brain death

BACKGROUND In brain death donors(BDDs),donor management is the key in the complex donation process.Donor management goals,which are standards of care or clinical parameters,have been considered an acceptable barometer of successful donor management.AIM To test the hypothesis that aetiology of brain death could influence haemodynamic management in BDDs.METHODS Haemodynamic data(blood pressure,heart rate,central venous pressure,lactate,urine output,and vasoactive drugs)of BDDs were recorded on intensive care unit(ICU)admission and during the 6-h observation period(Time 1 at the beginning;Time 2 at the end).RESULTS The study population was divided into three groups according to the aetiology of brain death:Stroke(n=71),traumatic brain injury(n=48),and postanoxic encephalopathy(n=19).On ICU admission,BDDs with postanoxic encephalopathy showed the lowest values of systolic and diastolic blood pressure associated with higher values of heart rate and lactate and a higher need of norepinephrine and other vasoactive drugs.At the beginning of the 6-h period(Time 1),BDDs with postanoxic encephalopathy showed higher values of heart rate,lactate,and central venous pressure together with a higher need of other vasoactive drugs.CONCLUSION According to our data,haemodynamic management of BDDs is affected by the aetiology of brain death.BDDs with postanoxic encephalopathy have higher requirements for norepinephrine and other vasoactive drugs.

急性颅脑外伤患者肠道菌群多样性差异对继发性全身炎症反应综合征的临床预测价值

目的探讨急性颅脑外伤患者肠道菌群多样性差异对继发性全身炎症反应综合征(SIRS)的临床预测价值。方法回顾性分析2022年1月—2023年12月固原市人民医院急诊重症监护病房和神经外科重症监护病房收治的急性颅脑外伤患者60例。按SIRS诊断标准分为单纯急性颅脑外伤组(非SIRS组)与急性颅脑外伤后继发性SIRS组(SIRS组);收集患者一般资料并进行临床指标检测,通过16S rRNA基因测序比较两组肠道菌群多样性与菌属相对丰度,采用Pearson相关性分析肠道菌群与临床指标的关系,采用受试者工作特征(ROC)曲线分析肠道菌群对SIRS的预测价值。结果两组患者性别构成、年龄、红细胞计数、血小板计数比较,差异均无统计学意义(P>0.05)。SIRS组体温较非SIRS组高、心率较非SIRS组快、白细胞计数较非SIRS组多、C反应蛋白水平较非SIRS组高(P<0.05)。两组患者Chao1和Shannon指数比较,差异均无统计学意义(P>0.05)。两组患者拟杆菌属、瘤胃球菌属、阿克曼菌属、粪肠球菌属相对丰度比较,差异均无统计学意义(P>0.05)。SIRS组普雷沃菌属相对丰度低于非SIRS组(P<0.05),埃希菌-志贺菌属、棒状杆菌属相对丰度均高于非SIRS组(P<0.05)。Pearson相关性分析结果表明,体温、心率、白细胞计数及C反应蛋白与普雷沃菌属相对丰度均呈负相关(r=-0.574、-0.539、-0.554和-0.572,均P<0.05);体温、心率、白细胞计数及C反应蛋白与埃希菌-志贺菌属相对丰度呈正相关(r=0.751、0.743、0.657和0.770,均P<0.05),与棒状杆菌属相对丰度均呈正相关(r=0.782、0.762、0.707和0.799,均P<0.05)。ROC曲线分析结果表明,联合诊断的预测效能最高,曲线下面积为0.946(95%CI:0.871,1.000),敏感性为96.7%(95%CI:0.902,0.100),特异性为93.3%(95%CI:0.844,0.100)。结论肠道菌群组成的变化与颅脑损伤后SIRS的发展密切相关,特定菌属的丰度变化可作为SIRS发展的早期生物预警信号。

沉默信息调节因子1激活剂SRT1720减轻大鼠急性颅脑损伤的机制

背景:有研究显示在急性颅脑损伤小鼠模型中,以药物激活沉默信息调节因子1的转录和翻译水平后能明显升高脑组织中沉默信息调节因子1的表达,降低脑组织炎症应激和氧化应激水平,改善神经功能。目的:探讨腹腔注射沉默信息调节因子1激活剂SRT1720减轻大鼠急性颅脑损伤的机制。方法:取90只SD大鼠,采用随机数字表法分为3组,每组30只:假手术组不造模;模型组、激活剂组建立急性颅脑损伤模型,6 h后假手术组、模型组、激活剂组分别腹腔注射二甲亚砜溶液、二甲亚砜溶液、SRT1720,1次/d,连续注射28 d。设定取材时间点,检测大鼠神经功能、脑组织含水量、脑组织氧化应激与炎症反应、脑组织形态、细胞凋亡与血管新生以及脑组织中沉默信息调节因子1蛋白表达。结果与结论:①注射7,14,28 d时,与假手术组比较,模型组大鼠改良神经功能缺损评分、脑组织含水量及细胞凋亡率均升高(P<0.05);与模型组比较,激活剂组大鼠改良神经功能缺损评分、脑组织含水量及细胞凋亡率均降低(P<0.05);②注射7,14,28 d时,与假手术组比较,模型组大鼠脑组织中活性氧自由基、髓过氧化物酶水平升高(P<0.05),血清中丙二醛、肿瘤坏死因子α和白细胞介素6水平升高(P<0.05),血清中超氧化物歧化酶水平降低(P<0.05);与模型组比较,激活剂组大鼠大鼠脑组织中活性氧自由基、髓过氧化物酶水平降低(P<0.05),血清中丙二醛、肿瘤坏死因子α和白细胞介素6水平降低(P<0.05),血清中超氧化物歧化酶水平升高(P<0.05);③注射7,14,28 d的免疫组化染色显示,模型组大鼠脑组织中新生血管数量多于假手术组(P<0.05),激活剂组大鼠脑组织中新生血管数量多于模型组(P<0.05);注射7,14,28 d的Western blot检测显示,模型组大鼠脑组织中沉默信息调节因子1蛋白表达低于假手术组(P<0.05),激活剂组大鼠脑组织中沉默信息调节因子1蛋白表达高于模型组(P<0.05);注射7,14,28 d的苏木精-伊红染色显示,激活剂组大鼠脑组织损伤程度轻于模型组;④结果表明,腹腔注射SRT1720通过下调急性颅脑损伤大鼠脑组织氧化和炎性应激水平、抑制神经细胞凋亡、促进血管新生来减轻脑组织损伤。

儿童急性硬膜下血肿继发大面积脑梗死危险因素分析

目的 分析急性硬膜下血肿(acute subdural hematoma,ASDH)术后继发大面积脑梗死患儿的临床表现和影像学特征,评估其潜在危险因素,为ASDH术后继发大面积脑梗死的预防、早期诊断和治疗提供依据。方法 回顾性研究4~12岁ASDH患儿的临床资料,所有患儿接受常规手术治疗。创伤后继发大面积脑梗死(massive cerebral infarction,MCI)是基于CT影像上低密度区域及临床体征诊断。回顾与患者预后相关的临床和影像学表现并进行统计学比较。采用多因素Cox回归分析对术后MCI进行初步评价,得出影响MCI的因素。结果 共纳入病例67例,32例列入MCI组,非MCI组35例。两组年龄(t=2.016,P=0.048)、体质量(t=2.389,P=0.020)、多发伤(χ^(2)=11.121,P=0.001)、GCS(Z=-4.730,P<0.001)、血肿体积(χ^(2)=12.890,P=0.002)、中线偏移度(mid-line shift,MLS;χ^(2)=12.261,P=0.002)及围手术期休克(χ^(2)=14.417,P<0.001)差异具有统计学意义。GCS(OR=0.322,P=0.002)、围手术期休克(OR=10.992,P=0.007)、多发伤(OR=6.547,P=0.046)与MLS (OR=46.974,P=0.025)是ASDH患儿发生MCI的主要风险因素。结论 围手术期休克、合并多发伤、GCS低评分和MLS大于10 mm是MCI的危险因素。具有多种危险因素的患儿MCI发生率显著提高。

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

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。

标准化系统护理对急性重症脑外伤患者的应用影响分析

目的:分析标准化系统护理对急性重症脑外伤患者的应用效果。方法:选取六合区人民医院80例急性重症脑外伤患者为研究对象,将其随机分为对照组和观察组,各40例。对照组进行常规护理;观察组将常规护理升级为标准化系统护理,对比两组患者预后。结果:观察组干预后NIHSS评分低于对照组,BI评分高于对照组(P<0.05);观察组干预后MMSE评分低于对照组,FMA评分高于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05)。结论:急性重症脑外伤患者中,开展标准化系统护理,对患者的神经功能、认知功能、肢体功能、生活自理能力有较好的改善作用,避免并发症发生,可促使患者尽早康复。

高原地区急性进展型硬膜外血肿致脑疝1例

急性硬膜外血肿(AEDH)是颅脑损伤后3 d内在硬脑膜和颅骨内板之间的潜在空间中出现的血肿。部分AEDH病例为进展型,早期症状较轻或被对冲伤症状掩盖,首次头颅CT检查未发现硬膜外血肿或血肿量较小,经过一段时间后复查头颅CT出现血肿或血肿增大,病情严重者,甚至出现脑疝,危及病人生命。本文报道1例高原地区的AEDH,为50岁男性,因高处坠落伤致头痛、头晕伴恶心呕吐0.5 h入院,GCS评分14分,首次头颅CT示左侧侧裂区片状高密度影,左侧颞枕部颅板下气体影,其内夹杂少量硬膜外血肿,右侧颞底硬膜下弧形高密度影。入院后6h发生病情变化,GCS评分7分,左侧瞳孔散大至5mm、对光反射消失,复查头颅CT示左侧颞枕部大面积硬膜外血肿形成,中线明显右移,左侧侧脑室受压变形。急诊全麻下行开颅血肿清除术。术后2 h复查头颅CT示左侧颞枕部硬膜外血肿清除彻底。术后6个月随访,病人GOS评分5分。这提示颅脑损伤病人,具有手术指征时要及早行开颅减压和血肿清除术。

联合LIPS和APACHEⅡ评分对重症创伤性脑损伤患者合并急性肺损伤的预测价值

目的探讨肺损伤预测评分(lung injury prediction score,LIPS)联合急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分对重症创伤性脑损伤(severe traumatic brain injury,sTBI)患者合并急性肺损伤(acute lung injury,ALI)的预测价值。方法回顾性选取2019年1月至2021年12月安徽医科大学附属省立医院收治的75例sTBI患者,根据是否合并ALI,将其分为ALI组(n=24)和非ALI组(n=51)。收集患者入院时的基本资料、实验室指标、APACHEⅡ评分、LIPS评分、格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分;采用Logistic回归分析sTBI患者合并ALI的危险因素,绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评价指标对sTBI合并ALI的预测价值。结果ALI组患者的APACHEⅡ评分、LIPS评分均显著高于非ALI组,GCS评分、红细胞体积分布宽度显著低于非ALI组(P<0.05)。Logistic回归分析显示,APACHEⅡ评分和LIPS评分升高及GCS评分降低均是sTBI合并ALI的独立危险因素(P<0.05)。ROC曲线分析显示,LIPS评分、APACHEⅡ评分诊断sTBI合并ALI的曲线下面积(area under the curve,AUC)分别为0.869和0.754;二者联合检测的AUC为0.916(95%CI:0.855~0.976),敏感度和特异性分别为83.4%和84.3%。结论LIPS评分联合APACHEⅡ评分可有效预测sTBI合并ALI的风险。

急性颅脑损伤院前院内一体化救护与转运管理

急性颅脑损伤(TBI)是导致创伤性死亡和神经功能障碍的首要原因。初次创伤后出现的低血压、缺氧和颅内高压等继发性损伤,会进一步加剧脑损伤。TBI的院前急救与护理的重点在于通过现场稳定伤情和迅速转运至适宜医院,以预防继发性脑损伤。及时有效的院前急救措施和早期护理干预,如纠正低血压、低氧状态、预防脑水肿等,可显著降低二次损伤的风险。院前急救作为TBI救治的首要环节,其重要性不言而喻;而院内的快速反应、多学科协同合作、急诊抢救与安全转运,则是高效救治的具体表现。实现院前与院内救治的无缝衔接和创伤中心一体化救护流程,可以大幅缩短救治时间,从而提高抢救成功率。本文对TBI的院前与院内一体化救护及转运流程管理模式进行综合性评述,以期为临床实践提供有益的参考。

院前指数法联合格拉斯哥昏迷评分在急性酒精中毒合并创伤性颅脑损伤患者评估中的应用

目的探究院前指数法(PHI)联合格拉斯哥昏迷评分(GCS)对急性酒精中毒合并创伤性颅脑损伤(TBI)患者的评估价值。方法随机选取2020年12月—2021年12月入住柳州市人民医院的院前急性酒精中毒合并TBI的患者200例作为研究对象。使用自行设计的PHI评分表及GCS对每位患者的信息进行详细记录。后期采用PHI联合GCS进一步分级,并与创伤严重程度(ISS)评分分级进行比较,以探究其评估结果。结果本研究共纳入200例院前急性酒精中毒合并TBI入院治疗患者,其中188例患者治愈出院,占94.0%;3例患者死亡,占1.5%;9例患者致残,占4.5%。PHI联合GCS评分为(5.53±3.80)分,ISS评分为(13.74±6.27)分。使用PHI联合GCS和ISS评分对院前急性酒精中毒合并TBI患者伤情的敏感性、特异性、准确度、阳性预测值、阴性预测值、Kappa值等评估指标差异均无统计学意义(P>0.05)。ROC曲线分析结果显示,PHI联合GCS和ISS评分法均能够对急性酒精中毒合并TBI患者的伤情进行评估。结论PHI联合GCS评分能够较好地评估急性酒精中毒合并TBI患者的病情,提供及时、精准的诊疗方案,从而提高治愈率。

基于决策树的急性创伤性脑损伤患者早期死亡风险分诊模型的构建及验证

目的构建并验证基于决策树的急性创伤性脑损伤(traumatic brain injury,TBI)患者早期死亡风险分诊模型,为急诊分诊提供准确、直观的新工具。方法回顾性收集某院急性TBI患者2287例的临床数据,构建早期死亡风险的分诊模型,采用十字交叉验证,并与改良早期预警评分(modified early waring score,MEWS)、修正创伤评分(revised trauma score,RTS)、改良快速急诊医学评分(the modified rapid emergency medicine score,mREMS)及损伤机制格拉斯哥年龄血压评分(mechanism,Glasgow coma scale,age and arterial pressure score,MGAP)比较预测效能。结果2287例急性TBI患者中,24 h内发生死亡者166例。决策树共3层,15个节点,筛选出6个解释变量,分别是瞳孔反应性、RTS、MGAP、MEWS、血氧饱和度及收缩压。决策树模型的受试者工作特征曲线下面积为0.917,高于MEWS、RTS、MGAP评分和mREMS,差异均有统计学意义(均P<0.05)。结论基于决策树构建的急性TBI患者早期死亡风险分诊模型能准确预测急性TBI患者24 h内死亡风险,可作为医护人员分诊的决策依据。

老年重症颅脑损伤患者发生急性创伤性凝血病的影响因素分析及列线图模型的建立

目的探究老年重型颅脑损伤(severe traumatic brain injury,STBI)患者发生急性创伤性凝血病的影响因素及列线图模型的建立。方法回顾性选取2020年1月-2023年6月在联勤保障部队第九〇九医院接受治疗的93例老年STBI患者作为研究对象,依照7∶3的比例使用R软件将其随机分为建模队列(n=65)和模型验证队列(n=28);同时根据患者是否发生急性创伤性凝血病(ATC),将建模列队分为ATC组(n=39)和非ATC组(n=26)。比较建模队列中2组的年龄、性别构成、BMI、ISS评分、收缩压、输液量、体温、动脉血PH、PT、APTT、FIB、D-DT、PLT值;采用二元多因素Logistic回归分析方法分析老年STBI患者发生ATC的影响因素,建立路线图预测模型并验证,ROC评价模型预测效能,校准曲线评估预测事件与实际事件的一致性,DCA曲线评价模型的有效性。结果建模队列ATC组ISS评分、输液量、PT、APTT及D-DT值显著高于非ATC组,而动脉血pH、GCS评分、PLT值显著低于非ATC组,差异均有统计学意义(P<0.05)。二元多因素Logistics回归分析结果显示,ISS评分、输液量、动脉血pH、GCS评分是老年STBI患者发生ATC的独立预测因子;模型公式:Logistic=-5.373+0.221 ISS评分+0.001输液量+0.469动脉血pH-0.232 GCS评分。采用R语言软件计算列线图模型的C统计量为:0.831,95%CI:0.778~0.879,标准误为0.025(P<0.001),10000 Bootstrap计算得出C统计量为0.822。所生成的列线图校准曲线斜率接近1,拟和度检验P值>0.05,预测事件与实际事件的一致性较高;该模型的ROC曲线下面积为0.826(95%CI:0.720~0.933),决策分析曲线显示收益率较高,也进一步证实列线图预测模型的有效性。基于模型验证队列,对ATC风险列线图以ROC曲线进行外部验证,ROC曲线下面积为:0.829(95%CI:0.675~0.983),所生成的列线图校准曲线斜率接近1,Hosmer-Lemeshow检验结果:χ^(2)=9.362,P=0.303,且决策曲线显示,该模型的净收益较高,提示列线图模型在验证组中的有效性。结论ISS评分、输液量、动脉血pH、GCS评分均可能是老年STBI患者发生ATC的独立预测因子;且进一步构建的老年STBI患者发生ATC的列线图预测模型表现出良好的预测能力,为临床识别老年STBI患者发生ATC的高风险人群提供了一定的帮助,有利于及时预防。