重型创伤性脑损伤患者去骨瓣减压术后短期死亡风险的影响因素分析  

Analysis of influencing factors of short-term mortality risk in patients with severe traumatic brain injury after decompressive craniectomy

作　　者：王如海 王绅 张敏 李春 韩超 于强 胡海成 李习珍 Ruhai Wang;Shen Wang;Min Zhang;Chun Li;Chao Han;Qiang Yu;Haicheng Hu;Xizhen Li(Department of Neurosurgery,the Second Affiliated Hospital of Fuyang Normal University(Fuyang Fifth People's Hospital),Fuyang 236000,China;the First School of Clinical Medicine,Lanzhou University,Lanzhou 730000,China;Department of Clinical Laboratory,Fuyang Hospital of Anhui Medical University,Fuyang 236112,China)

机构地区：[1]阜阳师范大学附属第二医院(阜阳市第五人民医院)神经外科,阜阳236000 [2]兰州大学第一临床医学院,兰州730000 [3]安徽医科大学附属阜阳医院检验科,阜阳236112

出　　处：《中华脑科疾病与康复杂志(电子版)》2024年第5期285-291,共7页Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition)

基　　金：阜阳市卫生健康委科研项目(FY2021-081、FY2023-019);阜阳师范大学横向医学研究专项项目(2024FYNUEY05)

摘　　要：目的探讨重型创伤性脑损伤(sTBI)患者去骨瓣减压术后短期死亡风险的影响因素。方法回顾性分析阜阳师范大学附属第二医院神经外科自2018年1月至2023年10月行去骨瓣减压治疗的154例sTBI患者的临床资料。根据sTBI患者术后14 d内是否死亡将患者分为死亡组和存活组。通过单因素分析及多因素Logistic回归分析,揭示sTBI患者去骨瓣减压术后短期死亡风险的独立影响因素。使用受试者特征工作(ROC)曲线及曲线下面积(AUC)评价不同影响因素对短期死亡风险的预测能力。结果154例sTBI患者中,51例患者在术后14 d内死亡,纳入死亡组,短期死亡发生率为33.1%,余103例生存患者纳入存活组。死亡组患者的入院时间、入院GCS评分、脑疝、创伤性脑梗死(PTCI)、血小板计数、血清总钙水平、血糖水平、肌酸激酶MB同工酶(CK-MB)、纤维蛋白原(FIB)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)与存活组比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,入院GCS评分、PTCI、TT是短期死亡风险发生的独立影响因素(P<0.05)。ROC曲线分析结果显示,入院GCS评分、PTCI、TT单独及联合预测短期死亡风险的AUC分别为0.806、0.697、0.715、0.896,其中3项指标联合预测的AUC和特异度高于单独预测。结论入院GCS评分、PTCI、TT联合应用能提高sTBI患者短期死亡风险的预测价值,临床实践中及时采取有效的干预措施,有助于改善患者的预后。Objective To investigate influencing factors of short-term mortality risk in patients with severe traumatic brain injury(sTBI)after decompressive craniectomy.Methods Clinical data of 154 sTBI patients after decompressive craniectomy admitted to Neurosurgery Department of the Second Affiliated Hospital of Fuyang Normal University(Fuyang Fifth People&apos;s Hospital)from January 2018 to October 2023 were retrospectively analyzed.The sTBI patients were divided into the death group and the survival group based on whether they died within 14 d after operation.Independent influencing factors for short-term mortality risk in sTBI patients after decompressive craniectomy were revealed by univariate and multivariate Logistic regression analysis.Receiver operating characteristic(ROC)curve and area under curve(AUC)were used to evaluate the ability of different influencing factors to predict the short-term mortality risk.Results Among 154 sTBI patients,51 cases died within 14 d after operation and were included in the death group,and the incidence of short-term mortality risk was 33.1%,the remaining 103 surviving patients were included in the survival group.There were statistically significant differences in admission time,GCS score on admission,cerebral hernia,posttraumatic cerebral infarction(PTCI),platelet count,serum total calcium concentration,blood glucose level,level of creatine kinase MB isoenzyme(CK-MB),level of fibrinogen(FIB),prothrombin time(PT),activated partial thromboplastin time(APTT)and thrombin time(TT)between the two groups(P<0.05).Multivariate Logistic regression analysis showed that GCS score on admission,PTCI,TT were independent influencing factors for short-term mortality risk(P<0.05).The ROC curve analysis results showed that the AUC values of admission GCS score,PTCI,TT alone and in combination for predicting short-term mortality risk were 0.806,0.697,0.715,0.896,respectively.Among them,the AUC and specificity predicted by the combination of three indicators were higher than those predicted separatel

关 键 词：重型创伤性脑损伤 去骨瓣减压 短期死亡风险 影响因素 

分 类 号：R651.1[医药卫生—外科学]