重度创伤性脑损伤患者预后的影响因素研究

目的：观察重度创伤性脑损伤(traumatic brain injury, TBI)患者预后的重要影响因素。方法：回顾性分析2012年1月1日—2018年12月31日于南通大学附属医院康复医学科住院的81例重度TBI 患者病历资料，以损伤3 个月后格拉斯哥预后评分(Glasgow outcome scale, GOS)为预后指标，观察影响重度 TBI 患者预后的相关因素。结果：81例重度TBI患者平均年龄(52±14)岁，其中男59例(72.8%)，交通事故伤 54 例(66.7%)。单因素分析显示与GOS相关的因素有年龄、高血压病史、手术史、入院格拉斯哥昏迷评分(Glasgow coma scale, GCS)、入院双瞳对光反射异常、受伤至入院天数、气管切开天数、昏迷天数、癫痫共9个变量差异均有统计学意义(均P<0.05)。多因素分析结果显示影响GOS的独立风险因素有年龄、入院GCS、昏迷天数、癫痫(P<0.05)。结论：年龄、入院GCS、昏迷天数、癫痫可作为判断重度TBI患者预后的依据。

Study on the influencing factors of prognosis in patients with severe traumatic brain injury*

Objective: To observe the critical factors influencing the prognosis of patients with severe traumatic brain injury(TBI). Methods: General information, medical history, and inpatient medical records of 81 patients with severe TBI who were admitted to the Department of Rehabilitation of the Affiliated Hospital of Nantong University from January 1, 2012 to December 31, 2018 were extracted retrospectively. The Glasgow outcome scale(GOS) after 3 months of injury was used as a prognostic indicator to observe the factors affecting the prognosis of patients with severe TBI. Results: The mean age of 81 patients with severe TBI was (52±14) years old, of which 59(72.8%) were male and 54(66.7%) were injured by traffic accidents. Univariate analysis showed that 9 factors were associated with GOS, including age, history of hypertension, history of surgery, Glasgow coma scale(GCS) at admission, abnormal pupil light reflection at admission, the interval from injury to admission, days of tracheotomy, days of coma, and epilepsy, the difference was statistically significant(P<0.05). Multivariate analysis showed that the independent risk factors affecting GOS were age, GCS at admission, days of coma, and epilepsy, the difference was statistically significant(P<0.05). Conclusion: Age, GCS at admission, days of coma, and epilepsy may be helpful in judging the prognosis of patients with severe TBI.