重型颅脑损伤死亡危险因素的分析

··陈华文　祝伟　李树生　郑智　　【】　。　150。　38.7%,、、、(P0.01)。　、、、、。【】;;RiskfactorsofseverecraniocerebralinjuryCHENHuawen,ZHUWei,LIShusheng,ZHENGZhi.IntensiveCareUnit,TongjiHospitalAffiliatedtoTongjiMedicalCollege,HuazhongUniversityofScienceandTechnology,Wuhan430030,China【Abstract】Objective　Toexploretheriskfactorsofseverecraniocerebralinjury.Methods　Onehundredandfiftypatientswithseverecraniocerebralinjurywerestudiedretrospectively.Allthepatientsweredividedintogroupsaccordingtodifferentlevelsofserumsugarandsodium,whethercomplicatedwithextracerebralorganinjury,earlyhypotensionorearlyhypoxemia.Thechi-squaretestwasusedtoexaminethemortalitybetweenthesegroups.Results　Thetotalmortalityofseverecraniocerebralinjurywas38.7%.Patientscomplicatedwithextracerebralorganinjury,earlyhypotension,earlyhypoxemia,hyperglycemia,andhypernatremiahadahighermortalitythanothers(P0.01).Conclusion　Themainriskfactorssevercraniocerebralinjuryareextracerebralorganinjury,earlyhypotension,earlyhypoxemia,hyperglycemiaandhypematremia.【Keywords】Severecraniocerebralinjury;Mortality;Riskfactors:430020　,ICU　　,,,。150,。1　1.1　2000820048150,,、、、、、、、、、、、、、、、、、GCS、APACHEⅡ、、。1.2　(1)　GCS8;(2)　《》145mmoL/L;(3)　6.1mmol/L;(4)　90mmHg;(5)　PaO260mmHg。1.3　SPSS10.0,χ2。2　98(65.3%),52(34.7%)。58,38.7%,32,26,4～78。:102(68.0%),40(26.7%),8(5.3%),72(48%),37(24.7%),38·216·20063153ChinJEmergMed,March2006,Vol.15,No.3(25.3%),45(30.0%)。、、,35(23.3%),28(18.7%),17(11.3%),138。,1。,2。,,、、、,3。1　Table1　Therelationbetweenhyperglycemiaandmortality(mmol/L)(n)(n)(%)6.1～11.120735.0＊11.1～18.1361747.2＊18.1～25.1161487.5　≥25.110990.0　　　:≥25.1mmol/L,＊P0.052　Table2　Therelationbetweenhypernatremiaandmortality(mmol/L)(n)(n)(%)146～16112541.7161～176171376.5＊≥17699100■　　:146～161mmol/L,＊P0.05;146～161mmol/L,■P0.013　Table3　Theriskfactorsofseverecraniocerebral(n)(n)(%)χ2P　　　844754.0226.530.01681116.18　　382771.0522.510.011123127.68　　　774659.7429.630.01731216.44　　613963.9327.680.01891921.35704361.4328.670.01801518.753　3.1　,,,(P0.01)。,,18mmol/L,87.5%,,[1]。,,-,;,,,、、,[2]。,,,[1]。,,,,,、、。,、、。3.2　:(1)　、、,ADH[3]。(2)　,、、。(3)　,,,,。,、,,,。,,·217·20063153ChinJEmergMed,March2006,Vol.15,No.3176mmol/L。,。,,,,[4]。3.3　,、、[5]。Arthur[5],17%33%。、、,、,,,,,。3.4　、、,,、。、。,、、、,。,,。,,,,,。[1],,.[J].,2003,2(1):25-26.QiJian,YuDingyong,TangWenguo.Therelationshipbetweenhyperglycemiaandprognosisinpatientswithseverheadinjury[J].ChinJNeuroMed,2003,2(1):25-26.[2],,.[J].,1996,8(2):70-72.ZhangSai,YangShuyuan,WangMinglu.Changesandsignificanceofbloodcatecholamineandglucoseinpatientswithacuteheadinjury[J].ChinJCriticalandEmergency,1996,8(2):70-72.[3],.[J].,2004,20(5):434-435.XuJiguang,LuJunlan.Effectofhypernatremiaonseverheadinjurypatients[J].ClinicalMedicineofChina,2004,20(5):434-435.[4],.[J].,2004,9(3):220-221.LiuYibing,ZhuYunfa.Applicationofhemodialysistotreathypernatremiaaftercraniotomy[J].ChinJNeurosurg,2004,9(3):220-221.[5]ArthurE,EugenF,DonaldF.Careofinjuredpatientsinthefield,duringtransport,andintheemergencydepartment[M].MultipleOrganFailure:pathophysiolgy,prevention,andtherapy.NewYork:Springer,2000:244.(:2005-10-17)(:)··《》2006(15)　　《》、,,、、,。《》、、、、、、、、,,,,。《》()、《(CA)》、《(EM)》、《》、《》、《》、《》、《CMCC》、《()》、《》。《》,A4,96,。200610.00,120.00。,32-41。。:88,:310009;:0571-87783951,:0571-87783647。E-mail:[e-mail]《》·218·20063153ChinJEmergMed,March2006,Vol.15,No.3