重型颅脑损伤早期死亡因素分析  

Anaylsis of the factors influencing early mortality in severe traumatic brain injury

作　　者：周世伟 王颖[2] 周杨 ZHOU Shiwei;WANG Ying;ZHOU Yang(Zhejiang Chinese Medical University,Zhejiang 310053,China;不详)

机构地区：[1]浙江中医药大学研究生院,杭州310000 [2]浙江省绍兴市人民医院

出　　处：《浙江创伤外科》2024年第8期1401-1404,共4页Zhejiang Journal of Traumatic Surgery

基　　金：浙江省医药卫生科技计划青年创新项目(2023RC287)。

摘　　要：目的探讨重型创伤性颅脑损伤早期死亡的影响因素。方法选取2022年1月至2022年11月绍兴市人民医院诊治117例重型创伤性颅脑损伤患者作为研究对象,根据死亡与生存分为两组,其中生存组63例,死亡组54例。采集重型颅脑损伤患者的相关临床资料,应用χ^(2)检验、t检验、单因素分析、多因素二元Logistic回归分析重型颅脑损伤患者早期死亡的危险因素。结果单因素分析显示年龄、入院时格拉斯哥昏迷评分(GCS)、是否脑疝、瞳孔大小、入院即刻血糖、乳酸脱氢酶、肌酸激酶、肌酸激酶同工酶(CKMB)、肌酐、凝血酶原时间、部分活化的凝血活酶时间、凝血酶时间、国际标准化比值(INR)、纤维蛋白原、白蛋白与重型颅脑损伤患者的早期死亡相关(P<0.05)。多因素Logistic回归分析显示年龄、GCS评分、乳酸脱氢酶、CKMB与重型颅脑损伤患者早期死亡的危险因素(P<0.05)。ROC曲线分析得出年龄、GCS评分、乳酸脱氢酶、CKMB、联合预测患者早期死亡的AUC分别为0.646、0.792、0.608、0.713、0.950;在最佳临界值对应的敏感度、特异度分别为:年龄为44.4%、84.1%;GCS评分为60.3%、88.9%;乳酸脱氢酶为72.2%、52.4%;CKMB为70.4%、65.1%;联合预测为81.5%、96.8%。结论重型创伤性颅脑损伤患者年龄、GCS评分、乳酸脱氢酶、CKMB与早期死亡相关,是独立的危险因素,这些指标联合对研究重型创伤性颅脑损伤患者早期死亡具有价值。Objective To investigate the factors influencing early mortality in severe traumatic brain injury.Methods A total of 117 patients with severe traumatic head injury diagnosed and treated in our hospital from January 2022 to November 2022 were enrolled as research subjects,and they were divided into two groups according to death and survival,including 63 cases in the survival group and 54 cases in the death group.The relevant clinical data of patients with severe craniocerebral injury were collected,and the risk factors for early death of patients with severe craniocerebral injury were analyzed byχ^(2) test,t-test,univariate analysis and multivariate binary logistic regression.Results Age,Glasgow Coma Score(GCS)on admission,herniation,pupil size,blood glucose immediately upon admission,lactate dehydrogenase,creatine kinase,creatine kinase isoenzyme(CKMB),creatinine,prothrombin time,partially activated thromboplastin time,thrombin time,international normalized ratio(INR),fibrinogen,albumin were associated with early mortality in patients with severe head injury analyzed by univariate analysis(P<0.05).Age,GCS score,lactate dehydrogenase and CKMB were independent risk factors for early mortality in severe TBI patients analyzed by multivariate logistic regression analysis(P<0.05).ROC curve analysis yielded area under the curve(AUC)values of 0.646 for age,0.792 for GCS score,0.608 for lactate dehydrogenase,0.713 for CKMB,and 0.950 for the combined prediction of early mortality.Sensitivity and specificity at the optimal cutoff values were as follows:age(44.4%,84.1%),GCS score(60.3%,88.9%),lactate dehydrogenase(72.2%,52.4%),CKMB(70.4%,65.1%),and combined prediction(81.5%,96.8%).Conclusion Age,GCS score,lactate dehydrogenase,and CKMB are independent risk factors associated with early death in patients with severe traumatic head injury,and these indicators together is valuable for studying the early death in patients with severe traumatic head injury.

关 键 词：重型颅脑损伤 危险因素 死亡 

分 类 号：R651.1[医药卫生—外科学]