伴颅脑损伤的多发伤病死率的影响因素分析

目的 探讨伴颅脑损伤（TBI）的多发伤病死率的危险因素。方法 回顾性分析2012年4月至2017年4月收治的638例伴TBI的多发伤的临床资料，采用多因素Logistic回归分析检验危险因素。结果 638例中，死亡99例，病死率为15.52%。多因素Logistic回归分析显示合并基础疾病、收缩压≤60 mmHg、创伤严重度评分≥25分、GCS评分≤8分、多发伤创伤数量>4处、受伤至入院时间≥4 h，以及合并休克、全身性炎症反应综合征、多器官功能不全综合征、急性呼吸窘迫综合征为伴TBI的多发伤病人病死率的独立危险因素（P<0.05）。结论 伴TBI的多发伤病死率较高，影响因素很多，临床应加强监测，并采取有效的救治措施。

Analysis of risk factors related to death in patients with multiple injuries associated with traumatic brain injury

Objective To analyze the risk factors related to the death in the patients with multiple injuries associated with traumatic brain injury (TBI). Methods The clinical data of 638 patients with multiple injuries associated with TBI treated in our hospital between April 2012 and April 2017 were retrospectively analyzed. The risk factors related to the death were analyzed by univariate and multivariate Logistic regression analysis, including sex, age, basic comorbidities, blood pressure, operation, injury severity score (ISS), GCS, systemic inflammatory response syndrome (SIRS), multiple organ dysfunction score (MODS), acute respiratory distress syndrome (ARDS) and so on. Results Of 638 patients, 539 survived and 99 died after the treatment. The univariate analysis showed that the factors related death included the basic comorbidities, blood pressure, ISS, GCS, shock, SIRS, MODS, ARDS, number of multiple injuries time from the injury to the treatment, number of platelet and blood glucose. The multivariate Logistic regression analysis showed that the independent risk factors related the death included the basic comorbidities, systolic pressure ≤60 mmHg, ISS ≥25 points, GCS score ≤8 points, SIRS, MODS, ARDS, and the number of multiple injuries >4, and time for the injury to the treatment ≥4 h (P<0.05). Conclusions The death rate is high in the patients with multiple injuries associated with TBI, especially in whom with GCS score ≤8 points, ISS ≥25 points and serious complications such as shock, SIRS, MODS and ARDS the close observation should be strengthened and the effective treatment measures should be taken.