重型创伤性脑损伤患者术后发生肠道屏障功能障碍的危险因素及其预警效能分析  

Analysis of risk factors and their warning effectiveness for postoperative intestinal barrier dysfunction in patients with severe traumatic brain injury

作　　者：丁春龙 陈俊杰 奚少东 周勤伟[1] 王辉军 邱杰 刘慧泽 张叶磊 郑昀旭 董富康 Ding Chunlong;Chen Junjie;Xi Shaodong;Zhou Qinwei;Wang Huijun;Qiu Jie;Liu Huize;Zhang Yelei;Zheng Yunxu;Dong Fukang(Department of Neurosurgery,Wuxi Branch of Zhongda Hospital Affiliated to Southeast University,Wuxi 214000,China)

机构地区：[1]东南大学附属中大医院无锡分院神经外科,无锡214000

出　　处：《中华创伤杂志》2024年第2期127-132,共6页Chinese Journal of Trauma

基　　金：无锡市科技发展医疗卫生指导性计划项目(WX03-02B0205-072101-34)。

摘　　要：目的探讨重型创伤性脑损伤(sTBI)患者术后发生肠道屏障功能障碍(IBD)的危险因素及其预警效能。方法采用回顾性队列研究分析2020年5月至2023年2月东南大学附属中大医院无锡分院收治的101例sTBI患者的临床资料,其中男63例,女38例;年龄21~81岁[(53.4±14.2)岁]。患者均行急诊手术。根据术后是否发生IBD,将患者分为IBD组(67例)和非IBD组(34例)。记录两组患者性别、年龄、基础疾病(高血压、糖尿病)、颅内血肿类型(硬膜下血肿、硬膜外血肿、脑内血肿)、术前格拉斯哥昏迷评分(GCS)、脑疝、术中初始颅内压(iICP)、手术时间、去除骨瓣、ICU治疗时间、肠内营养启动时间及使用广谱抗生素等。采用单因素及多因素二元Logistic回归分析,评估上述指标与sTBI患者术后发生IBD的相关性并确定其独立危险因素。采用受试者工作特征(ROC)曲线及曲线下面积(AUC)评价各危险因素对IBD的预警效能。结果单因素分析结果显示,术前GCS、脑疝、术中iICP、去除骨瓣、ICU治疗时间、肠内营养启动时间、使用广谱抗生素与sTBI患者术后发生IBD有一定的相关性(P<0.05或0.01),而性别、年龄、基础疾病、颅内血肿类型、手术时间与发生IBD不相关(P>0.05)。多因素二元Logistic回归分析结果表明,术前GCS≤5分(OR=2.49,95%CI 1.17,5.32,P<0.05)、术中iICP>23 mmHg(1 mmHg=0.133 kPa)(OR=1.20,95%CI 1.03,1.39,P<0.05)、肠内营养启动时间>24 h(OR=10.03,95%CI 1.26,80.21,P<0.05)与sTBI患者术后发生IBD显著相关。ROC曲线分析结果表明,术中iICP预警价值最大(AUC=0.91,95%CI 0.85,0.96),术前GCS次之(AUC=0.88,95%CI 0.82,0.95),肠内营养启动时间的预警价值最低(AUC=0.78,95%CI 0.69,0.87)。结论术前GCS≤5分、术中iICP>23 mmHg、肠内营养启动时间>24 h是sTBI患者术后发生IBD的独立危险因素。术中iICP对sTBI患者术后发生IBD的预警价值最大,术前GCS预警价值次之,肠内营养启动时间预警价Objective To investigate the risk factors and their warning effectiveness for postoperative intestinal barrier dysfunction(IBD)in patients with severe traumatic brain injury(sTBI).Methods A retrospective cohort study was conducted to analyze the clinical data of 101 patients with sTBI admitted to Wuxi Branch of Zhongda Hospital Affiliated to Southeast University from May 2020 to February 2023,including 63 males and 38 females,aged 21-81 years[(53.4±14.2)years].All the patients underwent emergency surgery.The patients were divided into IBD group(n=67)and non-IBD group(n=34)according to whether or not they had IBD after surgery.The gender,age,basic diseases(hypertension and diabetes),types of intracranial hematoma(subdural,epidural,and intracerebral hematoma),preoperative Glasgow Coma Scale(GCS),cerebral hernia,intraoperative initial intracranial pressure(iICP),operation time,removal of bone flap,treatment time in ICU,initiation time of enteral nutrition,and use of broad-spectrum antibiotics were recorded in the two groups.Univariate and multivariate binary Logistic regression analyses were conducted to assess the correlations between above-mentioned indicators and incidence of postoperative IBD in sTBI patients and determine the independent risk factors for sTBI.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the warning effectiveness of each risk factor for IBD.Results The results of the univariate analysis showed that preoperative GCS,cerebral hernia,intraoperative iICP,removal of bone flap,treatment time in ICU,initiation time of enteral nutrition,and use of broad-spectrum antibiotics were significantly correlated with the incidence of IBD in sTBI patients(P<0.05 or 0.01),while there were no correlations of IBD with gender,age,basic diseases,types of intracranial hematoma and operation time(P>0.05).The results of the multivariate binary Logistic regression analysis showed that preoperative GCS≤5 points(OR=2.49,95%CI 1.17,5.32,P<0.05),intraoperative iICP>23 mmHg(

关 键 词：颅脑损伤 肠 危险因素 肠道屏障功能 

分 类 号：R651.15[医药卫生—外科学]