昏迷危险因素的病例对照研究

目的研究昏迷发病的危险因素。方法连续收集223例住院的昏迷病人作为病人组(昏迷组).以同期住院的223例危重非昏迷病人为对照组(非昏迷组)。采用统一调查表和诊断标准对所有对象的一般情况、原发或主要疾病、急性并发症或器官衰竭、慢性脏器功能障碍等进行调查。应用单因素和多因素分析方法对有关因素进行分析。结果单因素分析表明,符合3项和4项标准的全身炎症反应综合征(SIRS 3-4)、急性呼吸衰竭、休克、急性肾衰、血糖过高、继发性全身性癫痫、第二原发疾病、原有脑软化,是昏迷的危险因素(P<0.05)。Logistic回归在校正了休克等因素后,SIRS3-4(OR=7.8,95％CI=4.307-14.001)、急性呼吸衰竭(OR=5.2,95％CI=1.683-16.242),继发性全身性癫痫(OR=2.6,95％CI=1.095-5.998)仍与昏迷密切有关。结论除昏迷的原发疾病外,多种急性并发症或器官衰竭,包括SIRS 3-4、急性呼吸衰竭、继发性全身性癫痫等,也是昏迷的主要危险因素。这些危险因素可以联合或单独作用引起昏迷。

A case-control study on the risk factors for coma

Objective To explore the coma risk factors. Methods 223 comatose patients consecutively hospitalized were set into coma group and the other 223 noncomatose critical patients in the same hospital at the same period as controls(noncoma group). An unified questionnaire and diagnostic standards were used to identify the general characteristics, the primary diseases, acute complications or organ failure, and chronic organ dysfunction ete. Univariate and multivariate analysis were used to explore the comatose risk factors. Results Single factor analysis identified the following risk factors: reaching 3 or 4 criteria for systemic mflammatory response syndrome (SIRS3-4), acute respiratory failure, shock, acute renal function failure, hyperglycemia, secondary generalized epilepsy, second primary diseases and preexisting cerebromalacia (P<0.05). in Logistic regression after adjusting other variables like shock, the variables significantly associated with coma were SIRS3-4 (OR=7.8, 95% CI=4.307-14.001), acute respiratory failure (OR=5.2, 95 % CI=1.685-16.242), and secondary generalized epilepsy (OR=2.6, 95% Cl=l.095-5.998). Conclusion Besides primary diseases for coma, multiple acute complications or organ failure, including SIRS3-4, acute respiratory failure, secondary generalized epilepsy, are also the main risk factors for coma. These risk factors, acting jointly or respectively, may be responsible for coma.