颅内压监测对重型颅脑创伤患者预后与疾病负担影响的队列研究  

The impact of intracranial pressure monitoring on severe traumatic brain injury prognosis and disease afflictions

作　　者：袁强[1] 刘华[1] 姚海军[1] 孙一睿[1] 吴惺[1] 吴雪海[1] 金毅[1] 高亮[1] 胡锦[1] 毛颖[1] 周良辅[1] 

机构地区：[1]上海复旦大学附属华山医院神经外科,上海市神经外科急救中心,200040

出　　处：《中华神经外科杂志》2013年第2期120-124,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金（30371454、81271375、81171133）;上海市科委重点科技攻关计划（08411952000）;上海市科委基础研究基金重点资助项目（10JC1402300）

摘　　要：目的了解颅内压（ICP）监测在重型颅脑创伤（TBI）患者中的应用情况及其对预后和经济负担的影响。方法抽取上海市5家二级以上综合性医院在2009年1月至2011年1月间收治的重型TBI住院患者535例，按是否行ICP监测分为两组（ICP组和非ICP组），对比两组患者的病死率，急性期总住院费用，住院天数，寿命年费用及质量调整寿命年费用。结果重型TBI患者行ICP监测的比例为28．0％。ICP组患者的住院病死率为16．7％，显著低于非ICP组患者的住院病死率32．2％（P〈0．001）。多元Logistic回归分析显示行ICP监测的患者死亡风险仅为非ICP监测患者的0．32倍（95％CI，0．19，0．54）。重型颅脑创伤患者行ICP监测可使病死率下降15．5％，但平均多耗费住院费用69620元（P〈0．001）；行ICP监测的寿命年费用中位数为5995元，显著高于未行ICP监测的寿命年费用中位数2236元（P〈0．001）；行ICP监测的质量调整寿命年费用中位数为11558元，显著高于未行ICP监测的寿命年费用中位数3938元（P〈0．001）。结论我国重型TBI行ICP监测的比例仍较低，重型TBI患者行ICP监测可能会增加经济负担，但却大大降低患者病死率。Objective To understand the use of intraeranial pressure （ICP） monitoring and to analyze its impact on the prognosis and eeonomic burdens in severe traumatic brain injury （TBI） patients. Methods A muhieenter study of five hospitals in Shanghai was performed. 535 severe TBI patients between January 2009 and January 2011 and related clinical variables were gathered from the five hospitals. The in - hospital mortality, total hospital costs, length of stay, the cost per life year, and the cost per quality - adjusted life year（QALY） between the ICP group and the non - ICP group were compared. Results The ratio of ICP monitoring in patients with severe traumatic brain injury was 28.00. The in - hospital mortality in the ICP group was 16. 7% , which was significantly lower than the in - hospital mortality in the non - ICP group（32. 2% ） （ P 〈0. 001 ）. Multivariate logistic regression analysis showed that the risk of death in the ICP group was only 0. 32 times （95% CI ,0. 19,0. 54） than the non -ICP group. The mortality could decrease 15.5% with ICP monitoring, but anaverage of 69,620 RMB was increased in hospital costs. The median cost per life year was 5,995 RMB in the ICP group, which was significantly higher than the non - ICP group （2,236 RMB） （ P 〈0. 001 ）. The median cost per QALY was 11,558 RMB in the ICP group, which was significantly higher than the non - ICP group （3,938 RMB） （ P 〈 0. 001 ）. Conclusion The proportion of ICP monitoring in severe traumatic brain injury was still low. ICP monitoring in severe traumatic brain injury patients could reduce mortality but increase the economic burdens of patients.

关 键 词：重型颅脑创伤 颅内压监测 预后 经济负担 

分 类 号：R651.15[医药卫生—外科学]