早期预后良好的重度颅脑损伤患者的临床特征及预后相关因素研究  

Research of clinical features and prognostic factors in patients with severe traumatic brain injury with good early prognosis

作　　者：冯爱平[1] 江涛[1] 刘伦波[1] 黄其军[1] 杜陈[1] Feng Ai-ping;Jiang Tao;Liu Lun-bo;Huang Qi-jun;Du Chen(Department of Neurosurgery,the Second People’s Hospital of Deyang City,Deyang 618000,China)

机构地区：[1]四川省德阳市第二人民医院神经外科,四川德阳618000

出　　处：《中国急救医学》2019年第6期559-563,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的评价早期预后良好的重度颅脑损伤(TBI)患者的临床特征及影响早期预后良好的因素,分析患者早期神经恢复的时间特点。方法选取2014年1月至2018年12月在我院神经外科重症监护病房(ICU)急救且治疗6个月后格拉斯哥预后(GOS)评分为4分(中度残疾组,n=90)或5分(恢复良好组,n=82)的172例患者的临床资料,比较中度残疾组患者与恢复良好组患者的临床指标,选取未纳入本研究但同期终止生命维持治疗的24例重度TBI患者(终止生命维持治疗组,n=24),比较终止生命维持治疗组患者和预后良好患者[格拉斯哥昏迷评分(GCS)评分为4~5分,n=172)]的临床资料,评价终止生命维持治疗对患者临床指标的影响。根据早期神经恢复时间不同将患者分为0~7 d组(n=114)、8~14 d组(n=22)、15~30 d组(n=20)与30~180 d组(n=16),比较各组患者的临床资料,评价影响患者早期神经恢复时间的因素。采用Pearson相关性分析评价患者治疗6个月GOS评分与出院、治疗1个月、治疗3个月GOS评分的相关性。结果患者的平均年龄(28.8±11.3)岁,致伤原因主要为汽车撞伤(58.1%,100/172)。与中度残疾组比较,恢复良好组患者入院GCS评分显著提高(t=2.480,P=0.014),入院时瞳孔不等发生率显著降低(χ^2=6.073,P=0.014),ICU住院时间(t=3.563,P<0.001)和总住院时间(t=4.989,P<0.001)显著降低。与有良好预后的重度TBI患者(n=172)比较,终止生命维持治疗(n=24)重度TBI患者GCS评分显著降低(t=7.386,P<0.001),双侧瞳孔不反射发生率显著提高(χ^2=8.131,P=0.004),入院马歇尔CT分级Ⅵ级的患者比例显著提高(χ^2=9.102,P=0.003)。大多数(66.3%,114/172)患者在伤后1周内能够完成指令动作,其中第1天恢复率最高(26.7%,46/172)。患者发病6个月时的GOS评分分别与发病1个月时的GOS评分(r=0.336,P<0.001)及3个月时的GOS评分(r=0.562,P<0.001)显著相关。结论重度TBI患者治疗2周后,仍有20.9%的患者能够完成指令动作[�Objective To evaluate the clinical features of the patients with severe traumatic brain injury (TBI) with good early prognosis and the factors that affect the early prognosis of patients.The time characteristics of early neurological recovery in patients were analyzed.Methods Clinical data of 172 patients who recovered well and the Glasgow outcome scale (GOS) score was 4 points (moderately disabled group,n=90) or 5 points (good recovery group,n=82) after 6 months of treatment in our neurosurgical intensive care unit (ICU) between January 2014 and December 2018 were included.The clinical indicators of patients with moderate disability and those with good recovery were compared.Twenty-four patients with severe TBI who were not included in the study but discontinued life-sustaining treatment at the same time (suspended life-sustaining treatment group,n=24) were included.The clinical data between the patients in the life-sustaining treatment group and the patients with good prognosis (GCS score 4 ~ 5 ,n=172) were compared.The effect of discontinuation of life-sustaining treatment on clinical indicators of patients were evaluated.The time distribution characteristics of early neurological recovery in patients were analyzed.Patients were divided into 0 ~ 7 days group (n=114),8 ~ 14 days group (n=22),15 ~ 30 days group (n=20) and 30 ~ 180 days (n=16) group according to the time of early neurological recovery.The clinical data of each group of patients were compared.The factors that influenced the timing of early neurological recovery in patients were evaluated.Pearson correlation analysis was used to evaluate the correlation between the 6-month GOS score and the GOS scores of patients discharged,treated for 1 month,and treated for 3 months.Results The average age of patients were (28.8 ± 11.3) years old.The main cause of injury was car injury (58.1%,100/172).Compared with the moderate disabled group,the GCS score of the patients in the good recovery group was significantly increased (￠=2.480,P=0.014),and the incidenc

关 键 词：重度颅脑损伤(TBI) 早期神经恢复 生命维持治疗 

分 类 号：R651.15[医药卫生—外科学]