影响重型颅脑损伤患者预后的临床因素分析

摘要

Objective To investigate influencing factors on the prognosis of severe craniocerebral injury. Methods A retrospective analysis of the clinical data of 64 patients with severe craniocerebral injury in this hospital from January 2008 to De-cember 2013. They were divided into the unfavourable prognosis group (30 cases) and the favourable prognosis group (34 cases) according to GOS in the three months after injury. The enrollment time,blood glucose,ISS,SpO2,SBP and GCS of the two groups were observed. It adopted multi-factor Logistic regression analysis method to analyze and compare potential relevant factors influ-cing prognosis. Results Comparing with the favourable prognosis group ,the patients in the unfavourable prognosis group was longer in hospitalized time,higher in blood glucose levels and ISS score,but lower in blood oxygen saturation,systolic blood pres-sure and GCS score. The differences were statistically significant (P<0.05). Cerebral hernia,CT line moving degree,ring pool shape,complications and basic diseases were independent relevant factors affecting the prognosis of patients with severe cranio-cerebral injury. Conclusion For the patients with severe craniocerebral injury ,establishing rapid and effective a treatment green channel,fully assessing the injury status of the patients,monitoring patient′s condition closely,treating craniocerebral injury and its complications positively as early as possible are beneficial to preventing the complications ,which make patients obtain effective treatment. It also accelerates the function recovery ,improves prognosis and promotes survival qulity.%目的：探讨影响重型颅脑损伤患者预后的临床因素。方法对2008年1月至2013年12月该院收治的64例重型颅脑损伤患者的临床资料进行回顾性分析，根据伤后3个月格拉斯哥预后评分（GOS）将其分为预后不良组（30例）和预后良好组（34例），观察两组患者入院时间、血糖、损伤严重程度评分（ISS）、血氧饱和度、收缩压以及格拉斯哥昏迷评分（GCS），采用多因素Logistic回归分析对两组患者中可能影响预后的相关因素进行分析和比较。结果与预后良好组比较，预后不良组患者的入院时间较长，血糖和ISS较高，而GOS分值、血氧饱和度、收缩压以及GCS分值较低，差异均有统计学意义（P<0.05）；脑疝、CT中线移动程度、环池形态、并发症及基础疾病是影响重型颅脑损伤患者预后的独立相关因素（OR=1.025、32.546、3.237、4.561，P<0.05）。结论对于重型颅脑损伤的患者，建立迅速有效的救治绿色通道，充分评估患者的损伤，密切监测病情的变化，早期积极地处理颅脑损伤和合并伤，预防并发症的发生，有利于患者得到及时有效的救治，在提高生存率的基础上可促进其功能的恢复，改善预后，提高生存质量。