重度颅脑创伤后垂体功能减退的发生现状及影响因素  

Occurrence and influencing factors of pituitary dysfunction after severe craniocerebral trauma

作　　者：罗方接 秦至臻 李小云 邓景阳 LUO Fangjie;QIN Zhizhen;LI Xiaoyun;DENG Jingyang(Department of Neurosurgery,Songshanhu Central Hospital,Dongguan 523326,China;Department of Neurooncology,the Third Medical Center of PLA General Hospital,Beijing 523326,China)

机构地区：[1]东莞市松山湖中心医院神经外科,523326 [2]解放军总医院第三医学中心神经肿瘤外科,北京100080

出　　处：《武警医学》2024年第12期1053-1057,共5页Medical Journal of the Chinese People's Armed Police Force

基　　金：广东省医学科学技术研究基金(B2024041)

摘　　要：目的 探讨重度颅脑创伤后垂体功能减退的发生现状及影响因素。方法 选取东莞市松山湖中心医院收治的200例重度颅脑创伤患者,依据患者是否发生垂体功能减退分为两组,即减退组(45例)和正常组(155例),调查并比较两组临床资料的差异性,对可能影响垂体功能的相关因素进行对比及logistics回归分析。结果 200例重度患者垂体功能减退发生率为22.50%,主要为甲状腺功能、肾上腺功能以及性腺功能。减退组患者格拉斯哥昏迷评分(GCS)<5分、颅内压≥20 mmHg、中线移位≥5 mm、脑疝、弥漫性脑水肿、颅底骨折、入住ICU时间>10 d、住院时间>28 d等发生率均高于正常组(P<0.05)。经logistics回归分析,垂体功能减退的危险因素包括GCS评分<5分、颅内压≥20 mmHg、中线移位≥5 mm、颅底骨折、弥漫性脑水肿。将GCS评分<5分、颅内压≥20 mmHg、中线移位≥5 mm、颅底骨折、弥漫性脑水肿纳入受试者工作曲线(ROC)分析,表明各危险因素联合共同预测垂体功能减退的临床价值更高。结论 重度颅脑创伤后垂体功能减退发生风险与颅内压、颅底骨折、弥漫性脑水肿、GCS评分等因素密切相关,临床应高度重视,及时干预,确保患者生命安全。Objective To investigate the current status and influencing factors of pituitary dysfunction after severe craniocerebral trauma.Methods A total of 200 patients with severe craniocerebral trauma admitted to Songshanhu Central Hospital in Dongguan City were selected and divided into two groups according to whether the patients suffered from hypopituitarism(45 cases)and normal group(155 cases).The differences of clinical data between the two groups were investigated and compared,the related factors that might affect pituitary function were compared and Logistics regression analysis was conducted.Results The incidence of pituitary dysfunction in 200 severe patients was 22.50%,mainly thyroid function,adrenal function and gonadal function.The incidence of Glasgow Coma Scale(GCS)score<5,intracranial pressure≥20 mmHg,midline displacement≥5 mm,cerebral herniation,diffuse cerebral edema,skull base fracture,ICU stay>10 days and hospitalization>28 days in the reduced group was higher than that in the normal group(P<0.05).According to logistic regression analysis,the risk factors for pituitary dysfunction included GCS score<5,intracranial pressure≥20 mmHg,midline displacement≥5 mm,skull base fracture and diffuse cerebral edema.The inclusion of GCS score<5,intracranial pressure≥20 mmHg,midline displacement≥5 mm,skull base fracture and diffuse cerebral edema in receiver operating characteristic(ROC)analysis had higher clinical value in predicting pituitary dysfunction by combining various risk factors.Conclusions The risk of pituitary dysfunction after severe craniocerebral trauma is closely related to factors such as intracranial pressure,skull base fractures,diffuse brain edema,GCS scores and other factors.Clinical attention and timely intervention should be paid to ensure the life safety of patients.

关 键 词：重度颅脑创伤 垂体功能减退 影响因素 干预 

分 类 号：R651.1[医药卫生—外科学]