重型颅脑损伤患者行去骨瓣减压术后红细胞压积值与短期预后的关系

摘要

目的:探究重型颅脑损伤患者行去骨瓣减压术后Hct值对短期预后的影响及其影响因素.方法:回顾性分析在我院行单侧去骨瓣减压术的重型颅脑损伤患者155例,记录其年龄、性别及手术前后的检验结果等信息;用单因素及多因素Logistic回归分析术后Hct值等因素对患者术后1月内的短期生存的影响;用多因素线性回归分析术后Hct值的影响因素;描述术后Hct值与患者短期预后的受试者特征工作(ROC)曲线.结果:行去骨瓣减压术的重型颅脑损伤患者术后短期死亡率约为29.03%(45/155);在多因素Logistic回归分析中,年龄(OR=1.043)、入院GCS评分(OR=0.716)、ISS评分(OR=1.126)及术后Hct值(OR=0.925)是影响重症颅脑损伤患者行去骨瓣减压术后短期生存的独立危险因素;在术后Hct值的多元线性回归分析中,入院GCS评分(β=0.299)、术前Hct值(β=0.480)和术中胶体输入量(β=－0.004)是影响术后Hct值的独立危险因素;在ROC曲线可算得术后Hct值对患者短期生存影响的最佳临界值约为25%(YI=0.225),诊断灵敏度为73.6%,特异度为48.9%;大于此值的短期生存率为79.5%.结论:去骨瓣减压术后Hct值是影响重型颅脑损伤患者短期预后的危险因素,术后Hct值不小于25%的患者短期生存率更高;入院的GCS评分、术前Hct较高或术中输注胶体液较少的患者,会使术后Hct值降低得更少.%Objective:To investigate the effects of hematocrit (Hct) on short-term prognosis in severe traumatic brain injury patients after undergoing decompressive craniectomy and the influencing factors of Hct. Methods:We retrospectively included in this study 155 severe head injury patients who underwent unilateral decompressive craniectomy in our hospital and collected information such as their age, gender, and test results before and after the operation. Univariate and multivariate logistic regression was applied to analyze the impact that post-surgery Hct and other factors have on short-term mortality one month after surgery. Multiple linear regression was used to study the influencing factors of Hct after surgery. The receiver operating characteristic (ROC) curve for Hct and short-term prognosis was described. Results:The short-term mortality of severe traumatic brain injury patients after undergoing decompressive craniectomy was 29.03% (45/155). Multivariate logistic regression analysis showed that age (OR=1.043), GCS score upon admission (OR=0.716), ISS score (OR=1.126), and Hct after surgery (OR=0.925) were the independent risk factors of short-term patient mortality after decompressive craniectomy. Multiple linear regression showed that GCS score upon admission (β=0.299), Hct before surgery (β=0.480), and volume of colloidal fluid infusion during surgery (β=-0.004) were independent influencing factors of post-surgery Hct. From the ROC curve, we found that the best critical value of post-surgery Hct was 25% (YI=0.225) and its sensitivity and specificity were respectively 73.6% and 48.9% ;greater than this, the short-term patient survival rate was 79.5% . Conclusion:The Hct after decompressive craniectomy in severe traumatic brain injury patients is a risk factor for short-term survival. Having a post-surgery Hct no less than 25% may result in a higher short-term patient survival rate. Patients with a higher GCS score upon admission and a higher Hct before surgery or those with a smaller colloidal fluid infusion during surgery may experience less Hct decrease after surgery.