[1]徐阳,崔慧琴,徐婷,等.老年重型颅脑损伤并发多脏器功能障碍的危险因素[J].中国临床神经外科杂志,2023,28(12):705-707711.[doi:10.13798/j.issn.1009-153X.2023.12.009]
 XU Yang,CUI Hui-qin,XU Ting,et al.Risk factors for multiple organ dysfunction in elderly patients with severe traumatic brain injury[J].,2023,28(12):705-707711.[doi:10.13798/j.issn.1009-153X.2023.12.009]
点击复制

老年重型颅脑损伤并发多脏器功能障碍的危险因素()
分享到:

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
28
期数:
2023年12期
页码:
705-707711
栏目:
论著
出版日期:
2023-12-31

文章信息/Info

Title:
Risk factors for multiple organ dysfunction in elderly patients with severe traumatic brain injury
文章编号:
1009-153X(2023)12-0705-03
作者:
徐阳崔慧琴徐婷顾仁丽
226600江苏,海安市人民医院创伤外科(徐阳、崔慧琴),神经外科(徐婷顾仁丽)
Author(s):
XU Yang1 CUI Hui-qin1 XU Ting2 GU Ren-li2
1. Department of Trauma Surgery, Hai'an People's Hospital, Hai'an 226600, China; 2. Department of Neurosurgery, Hai'an People's Hospital, Hai'an 226600, China
关键词:
重型颅脑损伤老年人多脏器功能障碍危险因素
Keywords:
Severe traumatic brain injury Elderly patients Multiple organ dysfunction Risk factors
分类号:
R 651.1+5
DOI:
10.13798/j.issn.1009-153X.2023.12.009
文献标志码:
A
摘要:
目的 探讨老年重型颅脑损伤并发多脏器功能障碍(MODS)的危险因素。方法 回顾性分析2018年3月至2023年2月收治的156例老年重型颅脑损伤的临床资料。住院期间,参照1995年全国危重病急救医学学术会议标准进行诊断MODS。结果 156例中,52例(33.33%)发生MODS。多因素logistic回归分析显示,入院GCS评分低、合并颅内感染、APACHE-Ⅱ评分高、动脉血气PH值下降以及APTT延长是老年重度颅脑损伤发生MODS的独立危险因素。ROC曲线分析回归模型预测老年重型颅脑损伤发生MODS的曲线下面积为0.93(95% CI:0.87~0.96),敏感性为84.62%(95% CI:71.9%~93.1%),特异性为95.19%(95% CI:89.1%~98.4%)。结论 MODS是老年重型颅脑损伤常见并发症。本文构建的回归模型对MODS具有一定预测作用。
Abstract:
Objective To investigate the risk factors for multiple organ dysfunction (MODS) in elderly patients (≥60 years) with severe traumatic brain injury (sTBI). Methods The clinical data of 156 elderly patients with sTBI treated from March 2018 to February 2023 were retrospectively analyzed. During hospitalization, MODS were diagnosed according to the criteria of the 1995 National Conference on Critical Care and Emergency Medicine. Results Of these 156 patients, 52 patients (33.33%) suffered from MODS. Multivariate logistic regression analysis showed that low admission GCS score, intracranial infection, high APACHE-Ⅱ score, decreased arterial blood PH and prolonged APTT were independent risk factors for MODS in the elderly patients with sTBI. ROC curve analysis showed that the area under the curve of the regression model constructed based on the above risk factors predicting MODS in the elderly patients with sTBI was 0.93 (95%CI: 0.87~0.96), the sensitivity was 84.62% (95%CI: 71.9%~93.1%), and the specificity was 95.19% (95%CI: 89.1%~98.4%). Conclusions MODS is a common complication of elderly patients with sTBI. The regression model constructed in this paper can predict MODS to some extent.

参考文献/References:

[1]COTTON BA, REDDY N, HATCH QM, et al. Damage control resuscitation is associated with a reduction in resuscitation volumes and improvement in survival in 390 damage control laparotomy patients [J]. Ann Surg, 2011, 254(4): 598-605.
[2]中国研究型医院学会休克与脓毒症专业委员会,中国人 民解放军战创伤学专业委员会,等. 创伤后多器官功能障碍综合征临床诊疗专家共识[J]. 中华危重病急救医学,2022,34(3):225-238.
[3]ZHAO W, LI H, LI J, et al. The mechanism of multiple organ dysfunction syndrome in patients with COVID-19 [J]. J Med Virol, 2022, 94(5): 1886-1892.
[4]王今达,王宝恩. 多脏器功能失常综合征(MODS)病情分期诊断及严重程度评分标准(经庐山’95全国危重病急救医学学术会讨论通过)[J]. 中国危重病急救医学, 1995,7(6):346-347.
[5]KILLIEN EY, ZAHLAN JM, LAD H, et al. Epidemiology and outcomes of multiple organ dysfunction syndrome following pediatric trauma [J]. J Trauma Acute Care Surg, 2022, 93(6): 829-837.
[6]KRISHNAMOORTHY V, KOMISAROW JM, LASKOWITZDT, et al. Multiorgan dysfunction after severe traumatic brain injury: epidemiology, mechanisms, and clinical management [J]. Chest, 2021, 160(3): 956-964.
[7]钱何布,郑志群,林兆凤,等. 重型颅脑损伤并发多器官功能障碍综合征的危险因素分析[J]. 创伤外科杂志,2003, 5(6):416-419.
[8]刘雪媛,孙 宇,高 敏,等. 预测危重创伤患者死亡的一种新评分系统:死亡预警评分的预测价值[J]. 中华危重病急救医学,2015,27(11):890-894.
[9]黄文娟,覃 松,孙 宇,等. 严重创伤患者MODS预警评分的建立及临床意义:一项多中心研究[J]. 中华危重病急救医学,2018,30(1):41-46.
[10]VLASTOS D, ZEINAH M, NINKOVIC-HALL G, et al. The effects of ischaemic conditioning on lung ischaemia-reperfusion injury [J]. Respir Res, 2022, 23(1): 351-363.
[11]HEMAUER SJ, KINGETER AJ, HAN X, et al. Daily lowest hemoglobin and risk of organ dysfunctions in critically ill patients [J]. Crit Care Med, 2017, 45(5): e479-e484.
[12]GANDO S, FUJISHIMA S, SAITOH D, et al. The significance of disseminated intravascular coagulation on multiple organ dysfunction during the early stage of acute respiratory distress syndrome [J]. Thromb Res, 2020, 191: 15-21.
[13]ZHAO Z, ZHANG J, LI N, et al. Disseminated intravascular coagulation associated organ failure in obstetric patients admitted to intensive care units: a multicenter study in China [J]. Sci Rep, 2021, 11(1): 16379.
[14]LEIMANIS-LAURENS ML, FERGUSON K, WOLFRUM E, et al. Pediatric multi-organ dysfunction syndrome: analysis by an untargeted "shotgun" lipidomic approach reveals lowabundance plasma phospholipids and dynamic recovery over 8-day period, a single-center observational study [J]. Nutrients, 2021, 13(3): 774-788.

相似文献/References:

[1]陈 彬 陈治标 刘 佳.早期同时行脑室-腹腔分流术+颅骨修补术治疗 重型颅脑损伤的疗效[J].中国临床神经外科杂志,2016,(05):304.[doi:10.13798/j.issn.1009-153X.2016.05.017]
[2]刘 军 袁辉纯 徐立新.体温控制对重型颅脑损伤血肿清除术后的疗效及血清IMA、MDA的影响[J].中国临床神经外科杂志,2016,(07):412.[doi:10.13798/j.issn.1009-153X.2016.07.008]
 LIU Jun,YUAN Hui-chun,XU Li-xin.Effects of body temperature on serum levels of ischemia-modified albumin and malondialdehyde after surgery for intracranial hematomas in patients with severe traumatic brain injury[J].,2016,(12):412.[doi:10.13798/j.issn.1009-153X.2016.07.008]
[3]郭宏伟 高玉松 罗新名 张松坡 胡承啸 扈俊华 柴 超 雷亚萍.重型颅脑损伤继发脑梗死的早期防治[J].中国临床神经外科杂志,2016,(07):416.[doi:10.13798/j.issn.1009-153X.2016.07.009]
 GUO Hong-wei,GAO Yu-song,LUO Xin-ming,et al.Treatment of delayed cerebral infarction after severe craniocerebral injury[J].,2016,(12):416.[doi:10.13798/j.issn.1009-153X.2016.07.009]
[4]皮水平 刘 杰 黄前樟.长期服用抗凝药物的老年颅脑损伤患者治疗体会[J].中国临床神经外科杂志,2016,(02):117.[doi:10.13798/j.issn.1009-153X.2016.02.022]
[5]宋晓阳 黎笔熙 陈 敏 甘国胜 秦明哲 程鹏飞 陶 军 周 翔.血栓弹力图在重型颅脑损伤患者围手术期的应用[J].中国临床神经外科杂志,2016,(01):17.[doi:10.13798/j.issn.1009-153X.2016.01.006]
 SONG Xiao-Yang,LI Bi-Xi,CHEN Min,et al.Application of thrombelastography to guiding perioperative treatment of patients with severe traumatic brain injury[J].,2016,(12):17.[doi:10.13798/j.issn.1009-153X.2016.01.006]
[6]马玉德 焦继超 杨伟科 徐泽红 王向宇.老年人急性硬膜下血肿12例的头颅CT演变与预后[J].中国临床神经外科杂志,2015,(06):360.[doi:10.13798/j.issn.1009-153X.2015.06.014]
[7]郭宏伟 高玉松 罗新民 扈俊华 尹一恒 张松坡 胡承啸.重型颅脑损伤继发应激性胃粘膜病变的危险因素分析[J].中国临床神经外科杂志,2015,(06):368.[doi:10.13798/j.issn.1009-153X.2015.06.018]
[8]任志文 赵 冬 刘 祺 王 惠 王业忠.亚低温对重型颅脑损伤患者血清MMP-9、颅内压和脑血流动力学的影响[J].中国临床神经外科杂志,2015,(07):398.[doi:10.13798/j.issn.1009-153X.2015.07.005]
 REN Zhi-wen,ZHAO Dong,LIU Qi,et al.Effect of mild hypothermia on serum level of MMP-9, intracranial pressure and cerebral blood flow dynamics in patients with severe craniocerebral injury[J].,2015,(12):398.[doi:10.13798/j.issn.1009-153X.2015.07.005]
[9]邹志鹏 杨 海 夏军勇 张化明 张 华 魏 恒 马江红.行血管内治疗的高龄颅内动脉瘤患者脑血管痉挛的临床分析[J].中国临床神经外科杂志,2015,(07):401.[doi:10.13798/j.issn.1009-153X.2015.07.006]
 ZOU Zhi-peng,YANG Hai,XIA Jun-yong,et al.Clinical analysis of symptomatic cerebral vasospasm after endovascular treatment of ruptured cerebral aneurysms in patients of 70 and over 70 years[J].,2015,(12):401.[doi:10.13798/j.issn.1009-153X.2015.07.006]
[10]刘福增 王 鹏 韩树生 殷尚炯 张建宇.改良T形切口去骨瓣减压术治疗重型颅脑损伤的疗效观察[J].中国临床神经外科杂志,2015,(07):424.[doi:10.13798/j.issn.1009-153X.2015.07.014]
[11]扈俊华 胡承啸 李玲玲 罗新名 柴 超 张晓娜 王凤仙 高玉松.控制性减压技术在老年重型、特重型颅脑损伤去骨瓣减压术中的应用[J].中国临床神经外科杂志,2020,(06):392.[doi:10.13798/j.issn.1009-153X.2020.06.018]

备注/Memo

备注/Memo:
(2023-08-23收稿,2023-10-26修回)
更新日期/Last Update: 2023-12-31