入院血清乳酸水平在重型颅脑损伤早期死亡风险评估中的价值  

Value of admission serom lactate in evaluation of early mortality risk for patients with severe traumatic brain injury

作　　者：张俊 胡锦 王海丽 郑锐哲 汪美华 张恒柱 王晓东 董伦 ZHANG Jun;HU Jin;WANG Hai-li;ZHENG Rui-zhe;WANG Mei-hua;ZHANG Heng-zhu;WANG Xiao-dong;Dong Lun(Department of Neurosurgery,Clinical Medical College of Yangzhou University,Yangzhou 225001,China;Department of Neurosurgery,Huashan Hospital,Fudan University,Shanghai 200052,China)

机构地区：[1]扬州大学临床医学院脑科中心,江苏扬州225001 [2]复旦大学附属华山医院神经外科,上海200052

出　　处：《中国临床神经外科杂志》2022年第9期736-738,共3页Chinese Journal of Clinical Neurosurgery

基　　金：江苏省非编码RNA基础与临床转化重点实验省级对外开放合作项目(201902);院级扶持项目(fcjs202050)。

摘　　要：目的 探讨入院血清乳酸水平在重型颅脑损伤(sTBI)早期死亡风险评估中的价值。方法 回顾性分析2017年6月至2021年5月收治的287例sTBI的临床资料。早期死亡指伤后1周内死亡,1周内放弃治疗自动出院也视为早期死亡。结果 287例sTBI中,早期死亡103例,早期病死率为35.89%;存活184例。早期死亡病人入院血清乳酸水平[6.5(4.7~9.0)mmol/L]明显高于存活病人[4.0(2.63~5.5)mmol/L;P<0.05]。多因素logistic回归分析显示,入院血清乳酸水平增高是sTBI早期死亡的独立危险因子(P<0.001)。ROC曲线分析显示,入院血清乳酸水平预测早期死亡的曲线下面积为0.765(95%CI 0.711~0.820),最佳截断值为5.25 mmol/L,灵敏度及特异度分别为70.9%、71.7%。结论 入院血清乳酸水平增高,sTBI早期死亡风险明显增加。这提示入院血清乳酸水平可作为sTBI早期死亡风险的评估指标。Objective To explore the value of admission serom lactate in evaluation of early mortality risk for the patients with severe traumatic brain injury(sTBI). Methods A retrospective analysis was performed on the clinical data of 287 sTBI patients who were admitted to our department from June 2017 to May 2021. The patients who died within 1 week after injury, or automaticly discharged from hospital within 1 week were regarded as early death. Results Early death occurred in 103 patients, with an early mortality rate of35.89%. The admission serum level of lactate [6.5(4.7~9.0) mmol/L] of the early death patients was significantly higher than that of the surviving patients [4.0(2.63~5.5) mmol/L;P<0.05]. Multivariate logistic regression analysis showed that increased serum level of lactate was an independent risk factor for early death of sTBI patients(P<0.001). ROC curve analysis showed that the area under the curve of admission serum lactate for predicting early death was 0.765(95% CI 0.711~0.820);the optimal cutoff value was 5.25 mmol/L;the sensitivity and specificity were 70.9% and 71.7%, respectively. Conclusions The increased admission serum lactate significantly increases the risk of early death in sTBI patients. This suggests that the admission serum lactate can be served as an evaluating factor for the early mortality risk of sTBI patients.

关 键 词：重型颅脑损伤 乳酸 血清水平 早期死亡 

分 类 号：R651.15[医药卫生—外科学]