颅内感染性疾病患者发生意识障碍的影响因素分析  

Analysis of risk factors in occurrence of conscious disorders in patients with intracranial infectious diseases

作　　者：郝彩江[1] 王义义[2] 朱虹 陆连第[2] Hao Caijiang;Wang Yiyi;Zhu Hong;Lu Liandi(General Intensive Care Unit,Tianjin Haihe Hospital,TCM Key Research Laboratory for Infectious Disease Prevention for State Administration of Traditional Chinese Medicine,Tianjin 300350,China;Department of Neurology,Tianjin Haihe Hospital,TCM Key Research Laboratory for Infectious Disease Prevention for State Administration of Traditional Chinese Medicine,Tianjin 300350,China)

机构地区：[1]天津市海河医院国家中医药管理局中医药防治传染病重点研究室重症医学科,天津300350 [2]天津市海河医院国家中医药管理局中医药防治传染病重点研究室脑系科,天津300350

出　　处：《中国中西医结合急救杂志》2021年第2期163-166,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家科技重大专项(2017ZX10305501005);天津市海河医院科技基金(HHYY-201803)。

摘　　要：目的探讨颅内感染性疾病患者发生意识障碍的危险因素.方法回顾性分析2018年1月至2019年12月天津市海河医院收治的颅内感染性疾病患者的临床资料,收集患者的性别、年龄、病因、病程、基础疾病(高血压、糖尿病)、其他部位感染情况(肺部感染、泌尿系感染)、体温、体格检查(脑膜刺激征、病理征)、外周血白细胞计数(WBC)、肝功能、有无低钠血症和低游离三碘甲状腺原氨酸(T3)综合征、腰椎穿刺结果(颅内压、脑脊液WBC水平、蛋白质水平、葡萄糖水平)、头部影像学表现(脑水肿、白质和皮质改变).根据是否发生意识障碍分为意识正常组和意识障碍组,比较两组各指标的差异,对可能影响意识障碍发生的因素进行二元Logistic回归分析.结果入选56例患者,其中意识正常组33例,意识障碍组23例.单因素分析显示,意识障碍组低T3综合征、便秘及结核性脑膜炎(TBM)患者比例均显著高于意识正常组〔低T3综合征:73.9%(17/23)比37.0%(10/27),便秘:91.3%(21/23)比24.2%(8/33),TBM:47.8%(11/23)比15.2%(5/33),均P<0.01〕,年龄以及病理征阳性、颅脑CT显示脑水肿、颅脑磁共振成像(MRI)显示白质病变的患者比例亦高于意识正常组〔年龄(岁):50.7±14.1比40.5±14.6,病理征阳性:43.5%(10/23)比15.2%(5/33),颅脑CT显示脑水肿:33.3%(7/21)比9.4%(3/32),颅脑MRI显示白质病变:54.5%(12/22)比24.2%(8/33),均P<0.05〕,而病毒性脑膜脑炎(VM)患者比例明显低于意识正常组〔39.1%(9/23)比66.7%(22/33),P<0.05〕.多因素Logistic回归分析显示,低T3综合征〔优势比(OR)=7.005,95%可信区间(95%CI)为1.317~37.243,P=0.022〕和便秘(OR=34.905,95%CI为5.277~230.892,P<0.001)是颅内感染性疾病患者发生意识障碍的独立危险因素.结论低T3综合征和便秘是颅内感染性疾病患者发生意识障碍的独立危险因素.Objective To explore the risk factors in occurrence of conscious disorders in patients with intracranial infectious diseases.Methods The clinical data of patients with intracranial infectious diseases in Tianjin Haihe Hospital from January 2018 to December 2019 were retrospectively analyzed.The gender,age,etiology,disease process,past history or basic diseases(hypertension,diabetes),infection at other sites(pulmonary infection,urinary tract infection),body temperature,physical examinations(meningeal irritation signs,pathological signs),peripheral blood leukocyte count(WBC),liver function,presence or absence of hyponatremia and low triiodothyronine(T3)syndrome,lumbar puncture results(intracranial pressure,cerebrospinal fluid WBC level,levels of protein and glucose)and head imaging findings(including cerebral edema,white matter and cortical changes)in the patients were collected.According to the occurrence of conscious disturbance or not,the patients were divided into two groups:conscious normal group and conscious disturbance group,and the differences of each index between the two groups were compared,The factors that might affect the occurrence of conscious disorders were analyzed by binary Logistic regression analysis.Results A total of 56 patients were enrolled in the study,and among them,there were 23 cases in conscious disturbance group and 33 cases in normal conscious group.The results of univariate analysis showed that the patients'incidences of low T3 syndrome,constipation and tuberculous meningitis(TBM)were significantly higher in conscious disturbance group than those in conscious normal group[low T3 syndrome:73.9%(17/23)vs.37.0%(10/27),constipation:91.3%(21/23)vs.24.2%(8/33),TBM:47.8%(11/23)vs.15.2%(5/33),all P<0.01].The age,the incidences of positive pathological signs,cerebral edema in craniocerebral CT and white matter lesions in craniocerebral magnetic resonance imaging(MRI)in patients of the conscious disturbance group were also significantly higher than those in the conscious normal group[age(year

关 键 词：颅内感染性疾病 意识障碍 LOGISTIC回归分析 低T3综合征 

分 类 号：R47[医药卫生—护理学]