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 周利兵 李莺 苏州大学附属儿童医院PICU 苏州 215003 【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1月至2013年8月收治的64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 64例中，车祸23例，溺水13例，跌（坠）落8例，颅脑肿瘤术后6例，脑血管意外4例，迟发型维生素K1缺乏4例，暴力伤4例，麻醉意外1例，机械伤1例。车祸、溺水和跌（坠）落是引起患儿TBI的主要原因。其中存活组36例，死亡组28例，病死率43.75%。相关危险因素t检验和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、活化部分凝血酶时间、乳酸脱氢酶、α-羟丁酸脱氢酶和肌酸激酶同工酶对儿童TBI预后有显著影响（P均＜0.05）；多因素Logistic回归分析共筛选出2个影响因素，分别是GCS（OR=29.081，CI 3.125-270.614，P=0.003）,血清乳酸（OR=10.609，CI 2.552-44.094，P=0.001）。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 中图分类号 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 64 TBI children admitted to PICU of childrens’ hospital of Suchow University between 2012 HYPERLINK /s?wd=January \t _blank January and 2013 HYPERLINK /s?wd=August \t _blank 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 glucose、albumin、activated partial thromboplastin time、