重型颅脑外伤患者入院后短期死亡的风险因素观察  

Risk factors of short-term death after admission in patients with severe craniocerebral trauma

作　　者：张华霖 费长东 周大伟 刘慎 毛琪 贾海江 ZHANG Hualin;FEI Changdong;ZHOU Dawei;LIU Shen;MAO Qi;JIA Haijiang(Emergency Medicine Department,Joint Logistic Support Force 967 Hospital,Dalian Liaoning 116000,China)

机构地区：[1]联勤保障部队第九六七医院急诊医学科,辽宁大连116000 [2]联勤保障部队第九六七医院神经外科,辽宁大连116000 [3]联勤保障部队第九六七医院质量管理科,辽宁大连116000

出　　处：《中国急救复苏与灾害医学杂志》2023年第7期884-887,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：辽宁省科学技术基金(编号:2019-ZD-1076)。

摘　　要：目的探讨重型颅脑外伤患者入院后短期死亡的风险因素。方法回顾性分析2019年5月—2021年5月在联勤保障部队第九六七医院神经外科治疗的重型颅脑外伤患者166例,根据入院后30 d的临床结局分为生存组(n=141)和死亡组(n=25),比较两组患者入院时临床资料的差异,使用单因素和多因素Logistic回归分析,分析重症脑损伤患者住院后短期死亡的危险因素,一致性分析各项危险因素联合预测重型颅脑外伤患者入院后短期死亡的效能。结果单因素分析,死亡组患者格拉斯哥昏迷量表(GCS)评分<5分占比、颅底骨折占比、低血压占比、蛛网膜下腔出血占比、硬膜下血肿占比、血肿量≥30 mL占比、瞳孔改变占比、颅高压占比均高于生存组(P<0.05);单因素分析中有差异信息纳入多因素Logistic回归分析,以死亡作为因变量,以GCS评分、血肿量、是否颅底骨折、是否低血压、是否蛛网膜下腔出血、有无硬膜下血肿、有无瞳孔改变、是否颅高压作为自变量,并行量化赋值。经多因素Logistic回归分析证实,GCS评分<5分、颅底骨折、低血压、蛛网膜下腔出血、硬膜下血肿、血肿量≥30 mL、瞳孔改变、颅高压均是重型颅脑外伤患者入院后短期死亡的危险因素(P<0.05);经一致性分析证实,各项危险因素联合预测重型颅脑外伤患者入院后短期死亡的灵敏度为0.880,特异度为0.956,准确率为0.970,阳性预测值为0.917,阴性预测值为0.979,Kappa=0.880。结论颅底骨折、低血压、GCS评分<5分、蛛网膜下腔出血、硬膜下血肿、血肿量≥30 mL、瞳孔改变、颅高压均是重型颅脑外伤患者入院后短期死亡的危险因素,针对这类患者应做好密切监测与干预,以最大可能减少患者死亡,改善预后。Objective To investigate the risk factors of short-term death in patients with severe craniocerebral trauma.Methods A retrospective analysis was made of 166 patients with severe brain injury who were treated by neurosurgery in the 967 Hospital of the Joint Service Support Force from May 2019 to May 2021.They were divided into survival group(n=141)and death group(n=25)according to the clinical outcome 30 days after admission.The clinical differences between the two groups at admission were compared.The risk factors of short-term death of patients with severe brain injury after hospitalization were analyzed using single factor and multiple factor Logistic regression analysis.The efficacy of combining various risk factors in predicting short-term mortality after admission in patients with severe traumatic brain injury was consistently analyzed.Results Univariate analysis showed that the proportion of GCS score<5,skull base fracture,hypotension,subarachnoid hemorrhage,subdural hematoma,hematoma volume≥30 mL,pupil change and cranial hypertension in death group were higher than those in survival group(P<0.05).The difference information in the univariate analysis was included in the multivariate Llogistic regression analysis.Death was taken as the dependent variable,and GCS score,hematoma volume,skull base fracture,hypotension,subarachnoid hemorrhage,subdural hematoma,pupil change,and intracranial hypertension were taken as independent variables,and the values were quantified simultaneously.Multivariate Logistic regression analysis confirmed that GCS score<5,skull base fracture,hypotension,subarachnoid hemorrhage,subdural hematoma,hematoma volume≥30 mL,pupil change,and cranial hypertension were all risk factors for short-term death in patients with severe head trauma after admission(P<0.05).The efficacy of combining various risk factors in predicting short-term mortality after admission in patients with severe traumatic brain injury was analysised.Conclusion GCS score<5 points,the fracture of the skull base and low

关 键 词：重型颅脑外伤 预后 单因素分析 多因素分析 

分 类 号：R651[医药卫生—外科学]