11937例急性颅脑创伤病人的预后因素分析

发布时间：2018-02-16 20:43

本文关键词： 中国颅脑创伤数据库颅脑创伤预后因素　出处：《上海交通大学》2015年博士论文　论文类型：学位论文

【摘要】：目的:对中国颅脑创伤数据库收录的急性颅脑创伤病人资料进行统计分析,研究急性颅脑创伤病人及重型颅脑创伤病人短期预后影响因素,并建立基于临床数据的预后预测模型。方法:11937例急性颅脑创伤病人资料均来自于中国颅脑创伤数据库,于入院24小时内开始资料采集,包括性别、年龄、伤因、入院格拉斯哥昏迷评分(Glasgow coma scale,GCS)评分、首次X线计算机体层摄影(computed tomography,CT)扫描情况、是否手术、二次CT扫描情况(有无迟发血肿)、是否二次手术、伤后第一、二、三、七、十,十四天体温、颅内压(intracranial pressure,ICP)、动脉血酸碱度(arterial PH),动脉血氧分压及出院时格拉斯哥预后评分(Glasgow outcome scale,GOS)。统计学分析采用SPSS19.0软件进行,单因素分析采用c2分析法,多因素分析采用logistic分析。结果:(1)11937例急性颅脑创伤病人包括:男性8768例(73.5%),女性3169例(26.5%),平均年龄41.89±0.46岁,高发年龄段为18-65岁(76.6%),伤因:车祸伤居首(53.5%),伤情分类:重型伤(GCS=3-8分)2776例(23.3%);2776例重型急性颅脑创伤病人包括:男性2121例(76.4%),女性655例(23.6%),平均年龄43.54±0.87岁,高发年龄段为18-65岁(82.1%);伤因中仍以车祸伤居首(66%)。(2)11937例急性颅脑创伤病人数据行单因素预后分析示:根据年龄、伤因、伤情、首次CT扫描情况(脑挫裂伤、蛛网膜下腔出血、脑疝、硬膜外血肿、硬膜下血肿,脑内血肿)、是否手术、二次CT扫描情况(迟发血肿)、伤后第一天体温、ICP、动脉血PH及血氧分压将病人分组,各组的死亡率及预后不良率(GOS=1-3分)差异均有统计学意义;而根据性别分组,两组死亡率差异无统计学意义,预后不良率有统计学意义;Logistic多因素回归分析示:伤情、伤后第一天体温、硬膜下血肿、迟发血肿、年龄及硬膜外血肿对死亡率有影响,预后预测模型为:P=1/(1+e-y),Y=-6.700+1.523×GCS评分-0.570×伤后第一天体温+0.517×硬膜下血肿+0.513×迟发血肿+0.461×年龄-0.376×硬膜外血肿,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)示曲线下面积(area under curve,AUC)为0.847,P=0.027为最佳危险值,对应灵敏度为0.867,对应特异度为0.652;伤情、迟发血肿、年龄、是否手术、硬膜外血肿、脑挫裂伤、伤后第一天体温及硬膜下血肿对预后不良率有影响,预后预测模型为:P=1/(1+e-y),Y=-6.497+1.655×GCS评分+0.663×迟发血肿+0.502×年龄+0.445×是否手术-0.428×硬膜外血肿+0.279×脑挫裂伤-0.271×伤后第一天体温+0.260×硬膜下血肿,绘制ROC曲线示AUC=0.878,P=0.182为最佳危险值,对应灵敏度为0.809,对应特异度为0.831。(3).2776例重型急性颅脑创伤病人数据行单因素分析示:根据年龄、伤情、脑挫裂伤、蛛网膜下腔出血、脑疝、硬膜外血肿、硬膜下血肿、脑内血肿、迟发血肿、伤后第一天体温、ICP、动脉血PH及血氧分压将病人分组,各组的死亡率及预后不良率差异有统计学意义;而根据是否手术分组,两组死亡率差异无统计学意义,预后不良率有统计学意义。Logistic多因素回归分析示:GCS评分、迟发血肿、硬膜外血肿、伤后第一天体温、年龄及硬膜下血肿对死亡率有影响,病人预后预测模型为:P=1/(1+e-y),Y=1.278-0.603×GCS评分+0.586×迟发血肿-0.519×硬膜外血肿-0.514×伤后第一天体温+0.452×年龄+0.379×硬膜下血肿,绘制ROC曲线示AUC=0.791,P=0.208为最佳危险值,对应灵敏度为0.752,对应特异度为0.706;迟发血肿、GCS评分、年龄、硬膜外血肿、脑挫裂伤、伤后第一天体温及脑内血肿对预后不良率有影响,病人预后预测模型为:P=1/(1+e-y),Y=1.988+0.842×迟发血肿-0.568×GCS评分+0.531×年龄-0.450×硬膜外血肿+0.428×脑挫裂伤-0.247×伤后第一天体温+0.214×脑内血肿,绘制ROC曲线示AUC=0.768,P=0.439为最佳危险值,对应灵敏度为0.760,对应特异度为0.653。结论:(1)男性成年为急性颅脑创伤高发人群,首要致伤原因为车祸伤,轻型颅脑创伤占多数,但重型颅脑创伤已超过中型而居第二位;(2)急性颅脑创伤病人的伤情、伤后第一天体温、硬膜下血肿、迟发血肿、年龄及硬膜外血肿对病人死亡率有影响;而伤情、迟发血肿、年龄、是否手术、硬膜外血肿、脑挫裂伤、伤后第一天体温及硬膜下血肿则对预后不良率有影响;(3)重型颅脑创伤病人的GCS评分、迟发血肿、硬膜外血肿、伤后第一天体温、年龄及硬膜下血肿对病人死亡率有影响;而迟发血肿、GCS评分、年龄、硬膜外血肿、脑挫裂伤、伤后第一天体温及脑内血肿则对预后不良率有影响。
[Abstract]:Objective : To study the factors influencing the short - term prognosis of patients with acute craniocerebral trauma and severe head trauma , and to establish a prognostic model based on clinical data . Results : ( 1 ) 11937 patients with acute craniocerebral trauma were male 8768 cases ( 73.5 % ) , female 3169 cases ( 26.5 % ) , average age 41.89 卤 0.46 years old , female 655 cases ( 76.6 % ) , average age 43.54 卤 0.87 years old , aged 18 - 65 years ( 82.1 % ) . ( 2 ) The prognosis of 11937 patients with acute craniocerebral trauma was analyzed by single factor analysis : according to age , wound , injury , first CT scan ( brain contusion , subarachnoid hemorrhage , cerebral hernia , epidural hematoma , hematoma of hard film , intracerebral hematoma ) , operation , secondary CT scan ( delayed hematoma ) , body temperature after injury , ICP , arterial blood PH and blood oxygen partial pressure . The prognosis prediction model was : P = 1 / ( 1 + e - y ) , Y = - 6.700 + 1.523 脳 GCS score - 0.557 脳 delayed hematoma + 0.461 脳 age - 0.376 脳 epidural hematoma , the corresponding sensitivity was 0.867 , the corresponding specificity was 0.652 , the injury , late hematoma , age , operation , The prognosis prediction model was as follows : P = 1 / ( 1 + e - y ) , Y = - 6.497 + 1.655 脳 GCS score + 0.663 脳 delayed hematoma + 0.502 脳 age + 0.445 脳 whether surgery - 0.428 脳 epidural hematoma + 0.279 脳 brain contusion - 0.271 脳 injured first day body temperature + 0.260 脳 hard - film hematoma , graph ROC curve shows AUC = 0.878 , P = 0.182 is the best dangerous value , the corresponding sensitivity is 0.809 , the corresponding specificity is 0.831 . ( 3 ) There was no significant difference in the mortality and prognosis of patients with severe acute craniocerebral trauma . The results showed that : P = 1 / ( 1 + e - y ) , Y = 1.278 - 0.603 脳 GCS , Y = 1.278 - 0.603 脳 GCS , Y = 1.278 - 0.642 脳 delayed hematoma - 0.568 脳 GCS score + 0.541 脳 age + 0.379 脳 hard - film hematoma . The prognosis of patients was 0.761 , P = 0.439 was the best dangerous value , the corresponding sensitivity was 0.760 , the corresponding specificity was 0.653 . Conclusion : ( 1 ) Male adult is the high incidence of acute craniocerebral trauma . The main cause of injury is accident injury , light craniocerebral trauma is the most , but the severe craniocerebral trauma is more than medium - sized and occupies second position ; ( 2 ) the patient ' s body temperature , hematoma , late hematoma , age and epidural hematoma have an influence on the mortality rate of patients after acute craniocerebral trauma ; ( 3 ) severe craniocerebral trauma patient ' s GCS score , delayed hematoma and epidural hematoma have an influence on the mortality rate of patients ; and ( 3 ) delayed hematoma , GCS score , age , epidural hematoma , brain contusion , first - day body temperature after injury and intracerebroventricular hematoma have an effect on prognosis .

【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R651.15

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