中老年脑外伤患者急性创伤性凝血病的危险因素分析

目的确定急性单纯性创伤性脑损伤(iTBI)是否是急性创伤性凝血病(acutetraumatic coagulation,ATC)的独立危险因素,以及评估与该并发症相关的危险因素.方法回顾性收集了2013年6月1日至2018年6月1日期间苏州大学附属第一医院符合研究标准的急性创伤患者345例.根据简明损伤评分量表(AIS评分)将纳入研究的患者分为三组:急性单纯性创伤性脑损伤组(iTBI组)、含TBI的多发伤组及非TBI的多发伤组.以ATC及进展性出血性损伤(progressive hemorrhagic injury,PHI)作为因变量,分别建立多因素Logistic回归模型,分析ATC、PHI的危险因素.结果本研究纳入了345例符合标准的患者作为研究对象,其中iTBI组78例;含TBI的多发伤组(TBI+组)120例;非TBI的多发伤组(NTBI组)147例.TBI+组患者ATC的发生率最高(36.7%),与类似损伤程度的NTBI患者比较,iTBI相关ATC的发生率并无明显升高.ATC患者的总体院内病死率为39.3%,而非ATC患者的总病死率为17.6%(P<0.01).iTBI不是发生凝血功能障碍的独立危险因素(OR 1.25,95%CI0.34~4.67,P=0.73).多变量分析确定了创伤严重程度评分(ISS)、格拉斯哥昏迷评分(GCS)≤8分、休克指数>1及年龄>75岁是创伤后凝血功能障碍的独立危险因素.多变量分析确定了ISS评分、INR>1.5及血小板计数(PLT)<100×109/L均与PHI独立相关.结论①iTBI不是发生凝血功能障碍的独立危险因素,但当其合并多发伤时则明显增加ATC的发生率.②ISS评分、GCS评分≤8分、休克指数>1及年龄>75岁是创伤后发生ATC的独立危险因素.③ISS评分INR>1.5及PLT<100×109/L均是PHI的独立危险因素.

Clinical analysis of risk factors for acute traumatic coagulopathy in middle-aged and elderly patients with traumatic brain injury

Objective To determine whether acute isolated traumatic brain injury(iTBI)is an independent risk factor for acute traumatic coagulopathy(ATC)and to assess the outcomes and risk factors associated with this complication.Methods A retrospective collection of 345 patients who met the study criteria during the period from June 1,2013 to June 1,2018 in the First Affiliated Hospital of Soochow University.Patients were divided into 3 groups according to the abbreviated injury scale(AIS score):isolated traumatic brain injury group(iTBI group);TBI combined with multiple trauma group(TBI+group);severe multi-system trauma with non-TBI group(NTBI group).Different factors such as ATC and progressive hemorrhagic injury(PHI)were used to establish different multivariate Logistic regression models to analyze the risk factors of ATC and PHI.Result A total of 345 eligible patients were included in the study,including 78 patients of iTBI group,120 patients of TBI+group,and 147 cases of NTBI group.Patients in the TBI+group had the highest incidence of ATC(36.7%),and there was no significant increase in the incidence of iTBI-related ATC compared with NTBI patients with similar degrees of injury.The overall in-hospital mortality rate was 39.3%for the patients with coagulopathy and 17.6%for non-coagulopathy patients(P<0.01).iTBI was not an independent risk factor for coagulopathy(OR 1.25,95%Cl 0.34-4.67,P=0.73).Multivariate analysis identified injury severity score(ISS),Glasgow coma scale(GCS)≤8,shock index>1,and age>75 years were independent risk factors for coagulopathy after iTBI.Multivariate analysis determined that ISS,PLT<100 x 10^9/L and INR>1.5 were independently associated with PHI.Conclusion①iTBI is not an independent risk factor for coagulopathy,but the incidence of ATC is significantly increased in the patients with iTBI combined with multiple trauma.②ISS,GCS≤8,shock index>1,age>75 years are independent risk factors for ATC after trauma.③ISS,INR>1.5 and PLT<100 x 10^9/L are independent risk factors for PHI.