血清阴离子变化与急性颅脑创伤的相关性研究  

Correlation study between changes in the serum anions and acute traumatic brain injury

作　　者：陶山伟 陈振波[1] 曾旭东 姚庆和 李坤航 于鸿业 张旭东 李立帅 李力卓 包义君[2,4] Tao Shanwei;Chen Zhenbo;Zeng Xudong;Yao Qinghe;Li Kunhang;Yu Hongye;Zhang Xudong;Li Lishuai;Li Lizhuo;Bao Yijun(Department of Neurosurgery,Luoyang Central Hospital Affiliated To Zhengzhou University,Luoyang 471009,China;Department of Neurosurgery,the First Affiliated Hospital of China Medical University,Shenyang 110001,China;Emergency Department of Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Neurosurgery,the Fourth Affiliated Hospital of China Medical University,Shenyang 110032,China)

机构地区：[1]郑州大学附属洛阳中心医院神经外科,471009 [2]中国医科大学附属第一医院神经外科,沈阳110001 [3]首都医科大学宣武医院急诊科,北京100053 [4]中国医科大学附属第四医院神经外科,沈阳110032

出　　处：《中华神经外科杂志》2020年第10期1008-1011,共4页Chinese Journal of Neurosurgery

基　　金：辽宁省自然科学基金(2020-MS-155)。

摘　　要：目的探讨急性颅脑创伤(TBI)后血清阴离子的变化与患者TBI严重程度及其预后的关系。方法回顾性分析2017年6月至2019年6月中国医科大学附属第一医院神经外科收治的82例急性TBI患者的临床资料。观察伤后48 h内血清阴离子(包括无机磷、氯离子、碳酸氢根、阴离子间隙)的变化情况,通过格拉斯哥昏迷评分(GCS)评估患者TBI的严重程度,采用格拉斯哥预后评级评估患者的预后。分析各项血清阴离子指标与患者TBI的严重程度及预后的关系。结果82例患者中,低血磷47例(57.3%),高血氯32例(39.0%),血碳酸氢根下降者31例(37.8%),血阴离子间隙增高者40例(48.8%)。急性TBI后低磷血症(r=0.363,P=0.001)和高氯血症(r=-0.273,P=0.013)均与TBI的严重程度存在相关性,即入院时TBI程度越重,患者的血磷越低,而血氯越高;血磷(r=0.311,P=0.004)和阴离子间隙(r=-0.254,P=0.021)与患者的预后也存在相关性,即血磷越低,血阴离子间隙越高,则患者的预后越差。结论急性TBI后,低血磷可提示患者的TBI严重,预后差。高血氯和阴离子间隙升高分别提示TBI严重和预后较差。Objective To investigate the changes of serum anion in patients with acute traumatic brain injury(TBI)and to evaluate its relationship with patients′prognosis.Methods A retrospective analysis was conducted on the clinical data of 82 patients with acute TBI admitted to Department of Neurosurgery,the First Affiliated Hospital of China Medical University from June 2017 to June 2019.Blood inorganic phosphorus,blood chlorine(Cl-),bicarbonate(HCO3-),and anion gap(AG)were selected as monitored indicators within 48 hours after injury.Glasgow coma score(GCS)was used to assess the severity of TBI,and Glasgow outcome scale(GOS)was used to evaluate the outcomes of patients.The relationship between those indicators and the severity and outcome of patients with TBI was analyzed.Results Among 82 patients,47(57.3%)had hypophosphatemia,32(39.0%)cases had hyperchloremia,31(37.8%)cases had decreased blood bicarbonate,and 40(48.8%)cases had increased blood anion gap.Both hypophosphatemia(r=0.363,P=0.001)and hyperchloremia(r=-0.273,P=0.013)following acute TBI were correlated with the severity of TBI,that is,lower blood phosphorus and higher blood chlorine indicated severer brain injury of the TBI patients at admission.The blood phosphorus(r=0.311,P=0.004)and anion gap(r=-0.254,P=0.021)were also related to the patient’s outcome,that is,lower blood phosphorus and higher blood anion gap indicated worse prognosis of the patients.Conclusions After acute TBI,hypophosphatemia may indicate the severity and poor prognosis of TBI patients.High blood chloride and elevated anion gap could also indicate severe TBI and poor prognosis respectively.

关 键 词：颅脑损伤 预后 阴离子 相关性 创伤性 

分 类 号：R651.15[医药卫生—外科学]