儿童重型颅脑损伤患者预后危险因素分析-南京医科大学.doc

儿童重型颅脑损伤患者预后危险因素分析 【摘要】目的 分析影响儿童重型颅脑损伤（traumatic brain injury，TBI）预后的相关危险因素。方法 回顾性分析苏州大学附属儿童医院儿童重症监护病房（Pediatric intensive care unit，PICU）2012年月至2013年月收治的例TBI患儿的临床资料，比较存活与死亡患者的临床特点，并进行相关均数t检验、多因素Logistic回归分析。结果 例中，车祸例，溺水例，跌（坠）落例，颅脑肿瘤术后例，脑血管意外例，暴力伤例，机械伤1例。车祸跌（坠）落引起患儿TBI的主要原因。其中存活组例，死亡组例，病死率%。相关危险因素t检验χ2检验结果显示，格拉斯哥评分(glasgow comas core，GCS）、儿童危重症评分(pediatric critical illness score，PCIS）、白蛋白、血清乳酸水平、血糖对儿童TBI预后有显著影响（P均＜0.05）；多因素Logistic回归分析共筛选出个影响因素，分别是GCS（OR=，CI ，P=0.00）,血清乳酸（OR=1，CI -44.094，P=0.0）。对并发症发生率行卡方检验，死亡组急性肾衰竭、高钠血症的发生率较存活组明显增加（P均＜0.05）。结论 GCS、血清乳酸水平是儿童TBI预后的独立危险因素，急性肾衰竭、高钠血症的发生对患儿的预后有显著影响。 关键词：儿童；重型颅脑损伤；预后；危险因素R720.597 Analysis of risk factors related to the prognosis of children with severe traumatic brain injury 【Abstract】 Objective to analyze the related risk factors influencing the prognosis of children with severe traumatic brain injury. Methods the clinical data of TBI children admitted to PICU of childrens’ hospital of Suchow University between 2012 January and 2013 August were analyzed retrospectively. The clinical features were compared between the survivors and non-survivors, T test、χ2 test and logistic regression analysis ware used.Results among the 64 patients, there were 23 with traffic accidents, 13 with drowning, 8 with falling, 8 with intracranial tumor operations, 4 with cerebrovascular accidents, 4 with late vitamin K1 deficiency,4 with violence injury, 1 with anesthetic accident and 1 with mechanical injury. Traffic accident、drowning and falling were the leading causes of children TBI. There were 28 survivors and 36 non-survivors and the mortality rate was 43.75%. T test of the associated risk factors showed that GCS、PCIS、albumin、serum lactic acid level、blood glucosealbumin、ctivated partial thromboplastin time、lactate dehydrogenase、alpha-hydroxybutyric dehydrogenase and creatine kinase isoenzymes had significant effect on the prognosis of children TBI（P0.05）. Two influencing factors were screened in the logistic regression analysis. The