重型颅脑损伤患者上消化道出血危险因素分析

目的分析影响重型颅脑损伤(severe head injury,SHI)患者上消化道出血的相关危险因素。方法回顾性分析2011-06—2013-12我院重型颅脑损伤患者的临床资料,比较发生上消化道出血患者与未发生患者的临床特点,并采用χ2检验进行单因素分析,将有统计学意义的变量再采用逐步Logistic回归进行多因素分析。结果 200例患者中发生上消化道出血者45例,发生率22.5%。与消化道出血相关的因素包括年龄、低血压、低氧血症、GCS评分、APACHEⅡ评分、瞳孔不等大、中线偏移、早期肠内营养、预防性用药差异均有统计学意义(P0.05);多因素Logistic回归分析共筛选出3个影响因素,分别是预防性用药(OR=6.92,95%CI:1.11~11.12,P=0.00)、早期肠内营养(OR=4.46,95%CI:1.44~13.83,P=0.01)和GCS评分(OR=3.51,95%CI:2.43~19.69,P=0.03)。上消化道出血组病死率较非出血明显增加(χ2=4.91,P=0.03)。结论预防性用药、早期肠内营养、GCS是重型颅脑损伤患者上消化道出血的独立危险因素,上消化道出血的发生对患者的预后有显著影响。

Risk factors analysis of upper gastrointestinal hemorrhage in patients with severe head injury

Objective To analyze the risk factors of upper gastrointestinal hemorrhage (UGH) in patients with severe head injury (SHI).Methods Clinical data of patients with SHI in our hospital from June 2011 to December 2013 were retrospectively analyzed.We compared clinical features of patients concomitant with UGH and those with non-UGH,and we performed univariate analysis by chi-square test,after that,variables of statistical significance were calculated by multiple factors analysis using stepwise Logistic regression.Results We recruited 200 cases,and 45 cases were accompanied by UGH,with the occurrence rate of 22.5％.Related risk factors of UGH included age,hypotension,hypoxemia,GCS scores,APACHE Ⅱ scores,anisocoria,midline shift,the early enteral nutrition,preventive medication (P＜0.05).Multiariable Logistic regression analysis indicated preventive medication (OR =6.92,95％ CI:1.11 to 11.12,P =0.00),early enteral nutrition (OR=4.46,95％ CI:1.44 to 13.83,P=0.01) and the GCS score (OR =3.51,95％ CI:2.43 to 19.69,P=0.03) had close relations with UGH.Furthermore,SHI patients with UGH had higher mortality than those without UGH (chi-square=4.91,P=0.03).Conclusion Preventive medicine,early enteral nutrition,GCS may be independent risk factors for upper gastrointestinal hemorrhage in patients with severe head injury,and the occurrence of upper gastrointestinal hemorrhage has a significant effect on the prognosis of patients.