重型颅脑损伤后钠钾紊乱等二次脑损伤因素对伤情的影响  

Influence of secondary brain injury factors such as sodium and potassium disturbances after severe traumatic brain injury

作　　者：吕伟豪 武秀权 郇宇 吴霜 何鑫 费晓炜 费舟 张磊 LYU Weihao;WU Xiuquan;HUAN Yu;WU Shuang;HE Xin;FEI Xiaowei;FEI Zhou;ZHANG Lei(Department of Neurosurgery,Xijing Hospital,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学西京医院神经外科,陕西西安710032

出　　处：《空军军医大学学报》2022年第4期424-427,431,共5页Journal of Air Force Medical University

基　　金：国家自然科学基金面上项目(81771239);军队后勤科研重大项目(AWS15J001)。

摘　　要：目的探讨重型颅脑损伤(sTBI)患者住院期间血钠、血钾紊乱频次与其早期伤情改变的关系。方法回顾性分析2013年10月至2019年6月空军军医大学西京医院神经外科重症监护室收治的454例sTBI患者临床资料。根据患者出院时的格拉斯哥预后评分(GOS)将其分为两组:转归良好组,GOS>3分;转归不良组,GOS≤3分。统计患者年龄,性别,住院期间血钠、血钾离子紊乱的频次等,采用单因素和多因素logistic回归分析判断影响伤情加重的危险因素,并通过绘制受试者工作(ROC)曲线评价伤情加重危险因素的诊断效能。结果在纳入人群中,伤情转归不良313例,伤情转归良好141例。单因素分析显示,年龄,住院期间血钠、血钾异常总频次与颅脑损伤(TBI)伤情改变相关(P<0.05)。多因素logistic回归分析显示,患者住院期间血钠、血钾发生异常总频次为加重TBI伤情的危险因素,ROC曲线提示住院期间血钠、血钾异常发生总频次可能具备一定的诊断效能。结论患者住院期间发生血钠、血钾异常总频次是TBI患者伤情加重的危险因素之一,其有可能成为一个简便的判断患者伤情改变情况的指标。Objective To explore the relationship between the frequency of blood sodium and potassium disturbances during the hospitalization of patients with severe traumtic brain injury(sTBI)and the changes in their early injury.Methods We retrospectively analyzed clinical data of 454 sTBI patients who were admitted to the neurosurgery intensive care unit of Xijing Hospital of Air Force Medical University from October 2013 to June 2019.According to the Glasgow Outcome Score(GOS)at discharge,the patients were divided into two groups:GOS>3 identified as the good outcome group and GOS≤3 as the poor outcome group.The age,gender,and the frequency of blood sodium and potassium disturbances during the hospitalization of patients were collected and analyzed using multivariate logistic regression analysis to find out risk factors of aggravating brain injury.The diagnostic efficacy of risk factors was evaluated by the receiver operating characteristic(ROC)curve.Results Among the 454 patients,313 had a bad outcome and 141 had a good outcome.Univariate logistic regression analysis showed that age and total frequency of abnormalities in serum sodium and potassium during hospitalization were directly related to changes in the severity of traumtic brain injury(TBI)(all P<0.05).Multivariate logistic regression analysis showed that the total frequency of abnormalities in serum sodium and potassium during hospitalization of patients were risk factors of aggravating TBI.ROC curve suggested that the total frequency of abnormalities in serum sodium and potassium during hospitalization had a certain diagnostic efficacy.Conclusion The total frequency of abnormalities in serum sodium and potassium during hospitalization is a risk factor of injury aggravation in patients with TBI,which can be used as a simple monitoring method to judge the changes of injury.

关 键 词：重型颅脑损伤 二次脑损伤 电解质紊乱 早期伤情转归 

分 类 号：R651[医药卫生—外科学] R447[医药卫生—临床医学] R711