天津医药

天津医药 ›› 2019, Vol. 47 ›› Issue (1): 63-66.doi: 10.11958/20180982

• 临床研究 • 上一篇    下一篇

弥漫性轴索损伤102例预后及相关因素分析

李民涛，贾竹亭，窦连峰，马会力，陈曦，李建军，孙胜房△   

  1. 基金项目：滨州医学院科技计划重点项目资助（BY2016KJ30） 作者单位：滨州医学院附属医院急诊外科（邮编256600） 作者简介：李民涛（1987），男，硕士，主治医师，主要从事颅脑外伤的临床研究 △通讯作者 E-mail: sunshengfang@163.com
  • 收稿日期:2018-06-22 修回日期:2018-12-03 出版日期:2019-01-15 发布日期:2019-01-15
  • 通讯作者: 孙胜房 E-mail:sunshengfang@163.com
  • 基金资助:
    滨州医学院科技计划重点资助项目《VSD技术+糜蛋白酶治疗严重软组织损伤的疗效观察》

Prognosis and analysis of associated factors in 102 patients with diffuse axonal injury

LI Min-tao, JIA Zhu-ting, DOU Lian-feng, MA Hui-li, CHEN Xi, LI Jian-jun, SUN Sheng-fang△   

  1. Department of Emergency Surgery, Binzhou Medical University Hospital, Binzhou 256600, China △Corresponding Author E-mail:sunshengfang@163.com
  • Received:2018-06-22 Revised:2018-12-03 Published:2019-01-15 Online:2019-01-15

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摘要： 目的 探讨弥漫性轴索损伤（DAI）患者预后并分析相关因素。方法 选取2016年1月—2018年1月我院 急诊外科收住院的DAI患者102例，根据患者受伤后6个月的存活情况分为生存组（n=70）和死亡组（n=32），DAI后6 个月时将其中67例存活患者根据细化型格拉斯哥预后评分（GOS-E）分为依赖组（n=8）和独立组（n=59）。利用患者 入院时和住院过程中的相关临床资料来分别分析 DAI 患者死亡和依赖相关的因素，采用新的损伤严重程度评分 （NISS）和Gennarelli临床分级评估患者脑损伤的严重程度，应用χ2检验及Fisher精确概率法分析患者入院和住院期 间相关因素的比例高低。结果 102例患者入院时损伤严重度评分（NISS）为（46.83±10.69）分，63.7%（65/102）的患 者Gennarelli临床分级为轻中度DAI，36.3%（37/102）为重度。与重度患者相比，轻中度DAI患者的存活率较高，生活 依赖率较低（P＜0.05）。入院时死亡组患者发生血糖异常、血氧饱和度（SpO2）异常和瞳孔异常比例高于生存组（P＜ 0.05）。住院期间死亡组患者发生其他并发症、脑出血（ICH）、血压异常比例高于生存组，DAI早期CT征象出现比例 低于生存组（P＜0.05），而依赖组ICU住院、感染、持续镇静药物使用、其他并发症、ICH高于独立组（P＜0.05）。结 论 （1）DAI患者损伤越重，死亡率越高，依赖性越高；（2）死亡组在入院时血糖异常、SpO2异常和瞳孔异常的发生比 例高；在住院期间血压异常、DAI早期CT征象、ICH、其他并发症的发生比例高。（3）依赖组在住院期间ICU住院、感 染、持续镇静药物使用、其他并发症和ICH的发生比例高。

关键词: 弥漫性轴索损伤, 格拉斯哥预后评分, 脑出血\创伤性颅脑损伤

Abstract: Objective To investigate the prognosis of 102 patients with diffuse axonal injury (DAI) and analyze the related factors. Methods A total of 102 DAI patients hospitalized in our hospital from January 2016 to January 2018 were divided into survival group (n=70) and death group (n=32) according to the 6-month survival after injury. The extended Glasgow outcome score (GOS-E) was used to describe the prognosis of patients who were survival at 6 months after injury, and these patients were subdivided into dependent group (n=8) and independent group (n=59). The chi-square test and Fisher's exact method were used to determine the factors associated with prognosis including mortality and dependence of patients. Results The new injury severity score (NISS) was (46.83 ± 10.69) for 102 patients at admission. The 63.7% of these DAI patients (65 / 102) were classified as mild or moderate DAI, and 36.3% of patients (37 / 102) were severe DAI. Patients with mild to moderate DAI showed higher survival rate and lower dependence rate on life than patients with severe DAI (P＜0.05). The incidence of abnormal blood glucose, abnormal SpO2 and pupillary abnormality were higher in the death group at admission than those in the survival group (P＜0.05). During hospitalization, the incidence of other complications, cerebral hemorrhage (ICH) and abnormal blood pressure were higher in the death group compared with those of survival group, but the proportion of early DAI signs on CT was lower in death group (P＜0.05). In the dependent group, ICU hospitalization, infection, continued sedative drug use, other complications and ICH were higher than those in the independent group (P＜0.05). Conclusion (1) The more severe the injury of DAI patients, the higher the mortality rate and dependence. (2) There are high incidence of abnormal blood glucose, SpO2 abnormality and pupillary abnormality at admission and high incidence of blood pressure abnormalities, early DAI signs on CT, ICH, and other complications during hospitalization in patients in the death group. (3) Patients in the dependent group show a high proportion of ICU hospitalization, infection, continued sedative drug use, other complications and ICH during hospitalization.

Key words: diffuse axonal injury, glasgow outcome scale, intracerebral hemorrhage, traumatic brain injury