合并伤对重型颅脑损伤患者近期预后的影响分析

目的探讨合并伤对重型颅脑损伤患者近期预后的影响。方法收集153例重型颅脑损伤合并多发伤患者的临床资料,依据患者伤后第28天或出院时GOS分为预后良好组(GOS4～5分)与预后差组(GOS1～3分),比较两组患者合并伤类型的差异性,对可能影响患者近期预后的因素进行单因素分析与Logistic多因素回归分析。结果单因素分析发现合并多发损伤、创伤性/失血性休克、颈椎损伤、胸部损伤、骨盆骨折、四肢骨折及创伤严重程度评分与重型颅脑损伤患者预后明显相关(P<0.05);logistic多因素回归分析示合并多发损伤、创伤性/失血性休克、颈椎损伤及胸部损伤为影响重型颅脑损伤患者近期预后的独立危险因素。结论合并多发损伤、创伤性/失血性休克、颈椎损伤及胸部损伤是影响重型颅脑损伤患者近期预后的独立危险因素。

Analysis of the impacts of associated injuries on short-term prognoses in the patients with severe head injury

Objective To investigate the impacts of associated injuries on short-term prognoses in the patients with severe head injury(SHI).Methods The clinical data of 153 SHI patients with associated injuries were analyzed retrospectively.Of these 153 patients,86 had good prognoses(GOS 4～5 points) and 67 poor prognoses(GOS 1～3 points) according to GOS 28 days after the injuries or on discharge from the hospital.Both the univariate analysis and logistic regression analysis were used to identify the risk factors related to their short-term prognoses.Results Univariate analysis showed that the factors significantly influencing short-term prognosis included associated multiple injuries,traumatic or hemorrhage shock,cervical spine injury,thoracic injury,pelvic fracture,extremities fractures and injury severity score in the patients with SHI(P <0.05).Logistic regression analysis showed that associated multiple injuries(OR 6.180;95%CI:2.618～14.244;P =0.000),traumatic or hemorrhage shock(OR 6.381;95%CI:2.681～15.189;P =0.000),cervical spine injury(OR 4.878;95% CI:1.122～21.214;P =0.035) and thoracic injury(OR 3.008;95% CI:1.275～7.482;P =0.013) were independent risk factors related to the prognoses in the patients with SHI.Conclusion The independent risk factors of poor prognoses include associated multiple injuries,traumatic or hemorrhage shock,cervical spine injury and thoracic injury in SHI patients with associated injuries.