GCS、Rotterdam CT评分联合中重度创伤性脑损伤并发症对其预后的预测价值  

The Predictive Value of GCS and Rotterdam CT Scoring Combined for the Prognosis of Moderate to Severe Traumatic Brain Injury Complications

作　　者：王盼 石泽亚[1,2,3] 高敏 徐芙蓉 邝小忠[1] 张珂 彭文娟 WANG Pan;SHI Zeya;GAO Min;XU Furong;KUANG Xiaozhong;ZHANG ke;PENG Wenjuan(Emergency Department,Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University,Changsha 410005;On site Rescue Clinical Research Center of Hunan Institute of Geriatrics,Changsha 410005;Hunan Occupational Disease Prevention and Control Institute,Changsha 410021)

机构地区：[1]湖南省人民医院/湖南师范大学附属第一医院急诊医学科,长沙410005 [2]湖南省老年医学研究所现场救护临床研究中心,长沙410005 [3]湖南省职业病防治院,长沙410021

出　　处：《湖南师范大学学报(医学版)》2024年第6期79-84,共6页Journal of Hunan Normal University(Medical Sciences)

基　　金：湖南省卫生健康高层次人才重大科研专项“公众急救科普‘湖南模式’实及效果的循证评价”(R2023072);2022年湖南省财政厅科研项目“老年心血管疾病患者院前急救预警响应模式的构建研究”(湘财教指[2022]75号);湖南省财政厅科研项目“于一键呼救的心脑血管病整体联动智慧急救模式构建研究”(湘财教指[2021]59号)

摘　　要：目的:探讨格拉斯哥昏迷量表评分(Glasgow coma scale score,GCS)联合鹿特丹(Rotterdam)CT评分及中重度创伤性脑损伤(traumatic brain injury,TBI)并发症对其预后的预测价值。方法:回顾性收集2020年1月—2022年12月本单位收治的144例中重度TBI患者一般资料、GCS评分、Rotterdam CT评分及其并发症情况。随访6个月并根据格拉斯哥预后量表(Glasgow outcome scale,GOS)评分,采用单因素及多因素Logistic回归分析以确定中重度创伤性脑损伤患者预后不良的独立危险因素。绘制受试者工作特征曲线(ROC曲线)并评价GCS、Rotterdam CT、中重度TBI患者并发症单独及联合对其预后不良的预测价值。结果:预后良好组102例,预后不良组42例,预后良好组出院GCS评分高于预后不良组,Rotterdam CT评分则低于预后不良组。多元Logistic回归分析显示GCS评分、RotterdamCT评分、并发症再出血的OR值分别为0.8(95%CI:0.68~0.92)、1.63(95%CI:1.14~2.34)、14.58(95%CI:2.29~92.69),是中重度TBI患者预后不良的独立预测因素。ROC曲线分析显示,GCS评分、Rotterdam CT评分、并发再出血对中重度TBI患者的预后不良均有预测价值,三者联合预测的AUC最大,为0.850(95% CI:0.771~0.929),敏感度为78.57%、特异度为83.33%。结论:GCS、Rotterdam CT评分及并发症再出血的组合对预测中重度TBI患者的预后效果最优。Objective To explore the predictive value of Glasgow Coma Scale score(GCS),Rotterdam CT score and complications of moderate-to-severe traumatic brain injury(TBI)for its prognosis.Methods A retrospective collection was made of 144 patients with moderate-to-severe TBI admitted to our unit from January 2020 to December 2022.General information,GCS scores,Rotterdam CT scores and their complication conditions of the patients were collected.After a 6-month follow-up,according to the Glasgow Outcome Scale(GOS).Univariate and multivariate Logistic regression analyses were used to determine the independent risk factors for poor prognosis in patients with moderate-to-severe TBI.Receiver operating characteristic curves(ROC curves)were drawn and the predictive values of GCS,Rotterdam CT,complications in patients with moderate-to-severe TBI alone and in combination for poor prognosis were evaluated.Results There were 102 cases in the good-prognosis group and 42 cases in the poor-prognosis group.The discharge GCS score of the good-prognosis group was higher than that of the poor-prognosis group,while the Rotterdam CT score was lower than that of the poor-prognosis group.Multivariate Logistic regression analysis showed that the OR values of GCS score,Rotterdam CT score and complication of rebleeding were 0.8(95%CI:0.68-0.92),1.63(95%CI:1.14-2.34)and14.58(95%CI:2.29-92.69)respectively,which were independent predictors of poor prognosis in patients with moderate-to-severe TBI.ROC curve analysis showed that GCS score,Rotterdam CT score and concurrent rebleeding all had predictive values for poor prognosis in patients with moderate-to-severe TBI.The combination of the three had the largest AUC,which was 0.850(95%CI:0.771-0.929),with a sensitivity of 78.57%and a specificity of 83.33%.Conclusion:The combination of GCS,Rotterdam CT score and complication of rebleeding has the best effect on predicting the prognosis of patients with moderate-to-severe TBI.

关 键 词：创伤性颅脑损伤 格拉斯哥昏迷评分 鹿特丹CT评分 并发症 格拉斯哥预后评分 

分 类 号：R651[医药卫生—外科学]