神经内分泌功能异常对颅脑创伤患者生存状况的影响

目的 探究神经内分泌功能异常对颅脑创伤患者生存状况的影响.方法 选取2013年1~12月于我院接受外科治疗的58例颅脑创伤患者为研究对象,根据病理学诊断后将38例下丘脑-垂体-肾上腺轴(HPA)功能障碍患者设为观察组,无HPA功能障碍的20例患者设为对照组,比较两组患者的住院时间;术后3 d对两组患者进行格拉斯哥昏迷评分(GCS);术后6个月采用生存质量评估量表(QOL)、生活自理能力自评量表(ADL)、改良式肢体运动功能量表(FMA)评估两组患者的生活质量;患者出院后进行为期三年的随访,比较两组患者出院1年、2年、3年生存率和复发率.结果 观察组患者的平均住院时间为(29.54±8.32)d,长于对照组的(8.23±5.64)d,GCS评分为(7.32±2.23)分,低于对照组的(12.87±1.32)分,差异均具有统计学意义(P<0.05);观察组患者的QOL评分、ADL评分和FMA得分分别为(87.3±4.4)分、(85.6±2.8)分和(81.8±4.1)分,均高于对照组的(80.2±3.8)分、(76.4±3.3)分和(74.1±3.7)分,差异均具有统计学意义(P<0.05);观察组患者出院1年、2年、3年的生存率分别为92.1%、88.6%、65.7%,对照组患者分别为100.0%、95.0%、90.0%;观察组患者出院1年、2年、3年复发率分别为13.1%、23.6%、36.8%,对照组分别为5.0%、15.7%、20.0%,观察组患者的生存率低于对照组,复发率高于对照组,差异均具有统计学意义(P<0.05).结论 颅脑创伤患者HPA轴功能与患者预后关系密切,HPA轴功能障碍的患者生存率低,恢复难度较大且生活质量差,需要加强治疗和护理.

Effect of neuroendocrine on the survival of patients with traumatic brain injury

Objective To explore the effect of neuroendocrine dysfunction on the survival of patients with trau-matic brain injury. Methods A total of 58 patients with craniocerebral trauma, who admitted to Department of Surgery of our hospital and underwent surgical treatment from January 2013 to December 2013, were selected and divided into the observation group (HPA dysfunction, n=38) and the control group (without HPA dysfunction, n=20) according to the pathological diagnosis of hypothalamic-pituitary-adrenal (HPA) axis dysfunction. The length of hospital stay of the two groups was compared. The Glasgow coma scale (GCS) was performed on the two groups of patients 3 days after surgery. Six months after surgery, the quality of life assessment scale (QOL) and activities of daily living (ADLs), Fugl-Meyer Assessment (FMA) were used to evaluate the quality of life of the two groups. The patients were followed up for three years after discharge, and the 1-year, 2-year, 3-year survival rate and the recurrence rate of the two groups were com-pared. Results The average hospitalization time of the observation group was (29.54 ± 8.32) days, which was signifi-cantly longer than (8.23 ± 5.64) days in the control group (P<0.05). The GCS score in the observation group was (7.32 ± 2.23), which was significantly less than (12.87 ± 1.32) in the control group (P<0.05). The scores of QOL, ADL, FMA of the observation group were respectively (87.3 ± 4.4), (85.6 ± 2.8), (81.8 ± 4.1), which were significantly higher than corre-sponding (80.2 ± 3.8), (76.4 ± 3.3), (74.1 ± 3.7) in the control group (P<0.05). The 1-year, 2-year, 3-year survival rates of the observed group were respectively 92.1%, 88.6%, and 65.7%, which were significantly higher than corresponding 100.0%, 95.0%and 90.0%of the control group (P<0.05). The 1-year, 2-year, 3-year recurrence rates of the observation group were respectively 13.1%, 23.6%, 36.8%, which were significantly lower than corresponding 5.0%, 15.7%, 20.0%in the control group (P<0.05). Conclusion The HPA axis function is closely related to the prognosis in patients with traumatic brain injury. The survival rate of patients with HPA dysfunction is low, with difficult recovery and poor quality of life, and the treatment and nursing need to be strengthened.