摘要
目的探讨重型创伤性脑损伤(traumatic brain injury,TBI)并发持续炎症-免疫抑制-分解代谢综合征(persistent inflammation immunosuppression catabolism syndrome,PICS)的危险因素。方法选取2013年3月~2017年3月西安交通大学第二附属医院、第一附属医院神经外科ICU及第二附属医院重症医学科收治的住院时间>14天的103例重型TBI患者作为研究对象,依据PICS诊断标准,将纳入的重型TBI患者分成43例PICS组和60例非PICS组。通过收集病例的一般临床资料、并发症发生情况及实验室检查数据,利用SPSS 19.0软件进行统计分析,将可能影响重型TBI患者并发PICS的危险因素引入Logistic回归分析,寻找并发PICS的独立危险因素。结果重型TBI患者中PICS组年龄、并发ARDS及机械通气的比例、住院天数均较非PICS组明显升高(P<0.05);PICS组CD4^+/CD8^+比值明显低于非PICS组(P<0.05),Logistic回归分析结果显示,年龄、并发ARDS、机械通气、CD4^+/CD8^+比值降低是影响重型TBI患者并发PICS的独立危险因素(P<0.05)。结论在重型TBI患者诊治中,高龄、并发ARDS、机械通气、CD4^+/CD8^+比值下降是其并发PICS的高危风险因素,早期干预上述危险因素可改善预后。
Objective To investigate the risk factors of persistent inflammatory-immunosuppressive catabolic syndrome(PICS)in patients with severe traumatic brain injury(TBI).Methods A total of 103 patients with severe TBI and the average length of hospital stay>14days were enrolled in the study.Patients with severe TBI were admitted to the Neurosurgical Intensive Care Unit of the Second and the First Affiliated Hospital of Xi′an Jiaotong University,Critical Care Medical Department of the Second Affiliated Hospital of Xi′an Jiaotong University from March 2013 to March 2017.According to the diagnostic criteria of PICS,patients were randomly divided into PICS group with 43 patients and non-PICS group with 60 patients.By collecting the general clinical data,complications and laboratory data of the cases,SPSS 19.0 software was used for statistical analysis to introduce risk factors that may affect the PICS in patients with severe TBI.Logistic regression was used to find independent risk factors for concurrent PICS.Results The age of the PICS group,the proportion of concurrent ARDS and mechanical ventilation,and the length of hospital stay were significantly higher in the severe TBI patients than in the non-PICS group(P<0.05).The ratio of CD4^+/CD8^+in the PICS group was significantly lower than that in the non-PICS group(P<0.05).Logistic regression showed that age,concurrent ARDS,mechanical ventilation,and decreased CD4^+/CD8^+ratio were independent risk factors for PICS in patients with severe TBI(P<0.05).Conclusion In the diagnosis and treatment of patients with severe TBI,the older age,concurrent ARDS,mechanical ventilation,and decreased ratio of CD4^+/CD8^+are high risk factors for concurrent PICS.Early intervention of these risk factors can improve the prognosis of severe TBI patients.
作者
张明
黄廷钦
马旭东
宋锦宁
赵君杰
席红娜
王睿智
Zhang Ming;Huang Tingqin;Ma Xudong(Department of Neurosurgery,The Second Affiliated Hospital of Xi′an Jiaotong University,Shaanxi 710004,China)
出处
《医学研究杂志》
2019年第10期86-90,共5页
Journal of Medical Research
基金
中央高校基本科研业务费专项资金资助项目(xjj2015018)
西安交通大学第二附属医院人才培养专项科研基金资助项目[RC(XM)201603]
关键词
重型颅脑损伤
持续炎症-免疫抑制-分解代谢综合征
危险因素
预后
Traumatic brain injury(TBI)
Persistent inflammation immunosuppression catabolism syndrome(PICS)
Risk factor
Prognosis
