急性创伤性脑损伤发生心脏收缩功能障碍的危险因素分析  

Analysis of risk factors for cardiac systolic dysfunction in acute traumatic brain injury

作　　者：姚乐[1] 黄祖荣[1] 聂云辉 Yao Le;Huang Zurong;Nie Yunhui(Department of Emergency,Beihai People’s Hospital,Beihai,Guangxi 536000,China)

机构地区：[1]北海市人民医院急诊科,广西北海536000

出　　处：《创伤外科杂志》2021年第4期245-249,共5页Journal of Traumatic Surgery

摘　　要：目的评估早期急性创伤性脑损伤(TBI)患者是否存在心脏收缩功能障碍,并对相关危险因素进行分析。方法回顾性分析2018年7月—2019年7月北海市人民医院收治的63例急性创伤性脑损伤(TBI)患者资料,根据有无心脏收缩功能障碍(左室长轴缩短率<25%)分为障碍组(21例)和无障碍组(42例)。均因道路交通伤(38例)或摔伤(25例)导致。障碍组男性14例,女性7例;年龄38~55岁,平均42.0岁;无障碍组男性30例,女性12例;年龄39~54岁,平均43.2岁。运用Logistic回归分析心脏收缩功能障碍的相关危险因素。结果障碍组入院时格拉斯哥昏迷评分(GCS)显著低于无障碍组(7.96±2.71)分vs.(13.73±1.52)分(P<0.001)。头颅CT显示障碍组的脑室内出血比例较高(P<0.001)。超声心动图结果显示在心脏收缩功能相关参数中,障碍组的左室射血分数(LVEF)和左室长轴缩短率(LFS)与无障碍组相比(0.52±0.07)vs.(0.57±0.07)、(0.22±0.05)vs.(0.36±0.10),均显著降低(P<0.001),而左心室收缩末期内径(LVIDs)(3.94±0.62)cm vs.(3.21±0.45)cm明显增大(P<0.001)。多因素分析显示GCS(OR3.964;95%CI2.92~5.03,P<0.001)、收缩压变化程度(OR2.115;95%CI1.48~2.74,P<0.001)以及平均动脉压变化程度(OR1.647;95%CI-1.04~2.25,P<0.001)与急性TBI患者发生心脏收缩功能障碍独立相关。结论入院时GCS、收缩压变化程度以及平均动脉压变化程度与急性TBI后心脏收缩功能障碍的发生独立相关。Objective To evaluate the existence of systolic dysfunction in early traumatic brain injury(TBI)and the related risk factors of cardiac systolic dysfunction.Methods A total of 63 patients with acute traumatic brain injury admitted to Department of Emergency,Beihai People's Hospital from Jul.2018 to Jul.2019 were selected.According to whether there was cardiac systolic dysfunction,they were divided into disorder group(21 cases)and non-disorder group(42 cases).In the disorder group,there were 14 males and 7 females,with an average age of 42.0 years(range,38-55 years);in the non-disorder group,there were 30 males and 12 females;with an average age of 43.2 years(range,39-54 years).All patients suffered head injuries due to traffic accidents or falls.Logistic regression was used to analyze the related risk factors of cardiac systolic dysfunction.Results The Glasgow coma score(GCS)on admission in the disorder group was significantly lower than that of the non-disorder group[(7.96±2.71)points vs.(13.73±1.52)points](P<0.001).Head CT showed a higher proportion of intraventricular hemorrhage in the disorder group(P<0.001).The results of echocardiography showed that among the parameters related to systolic function,the left ventricular ejection fraction(LVEF)and the longitudinal fractional shortening(LFS)of the disorder group were decreased significantly compared with those of the non-disorder group[(0.52±0.07)vs.(0.57±0.07),(0.22±0.05)vs.(0.36±0.10)],P<0.001,while the left ventricular internal end systolic diameter(LVIDs)[(3.94±0.62)]cm vs.(3.21±0.45)cm]increased significantly(P<0.001).Multivariate analysis showed that the GCS(OR:3.964;95%CI:2.92~5.03,P<0.001),the degree of change in systolic blood pressure(OR:2.115;95%CI:1.48~2.74,P<0.001)and the degree of change of mean arterial pressure(OR:1.647;95%CI:-1.04~2.25,P<0.001)were independently related to the occurrence of systolic dysfunction in patients with acute TBI.Conclusion GCS,degree of SBP and MAP change at admission are independently related to the occurrenc

关 键 词：创伤性脑损伤 心脏收缩 功能障碍 危险因素 

分 类 号：R651.1[医药卫生—外科学]