| 谢晨阳,陈秀侠.重型颅脑损伤术中血压变异性对预后的影响[J].安徽医药,2020,24(1):33-38. |
| 重型颅脑损伤术中血压变异性对预后的影响 |
| The prognosis of intraoperative blood pressure variability in patients with severe traumatic brain injury |
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| DOI：10.3969/j.issn.1009?6469.2020.01.009 |
| 中文关键词: 颅脑损伤/诊断 脑膨出 血压 预后 危险因素 血压变异性 |
| 英文关键词: Craniocerebral trauma/diagnosis Encephalocele Blood pressure Prognosis Risk factors Blood pressure variability |
| 基金项目: |
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| 中文摘要: |
| 目的探讨重度颅脑损伤病人术中血压变异性对伤后 3个月预后的影响。方法本研究采用观察性横断面研究，选取徐州医科大学附属医院 2014年 7月至 2017年 12月期间重型颅脑损伤且接受开颅手术治疗的 87例病人的临床资料，病人按照伤后 3个月 GOS预后评分分为良好组( GOS4?5分)和不良组( GOS1?3分)，分析血压变异性(收缩压标准差)、收缩压平均数对预后的影响；同时纳入的因素有年龄、入院时间、 GCS评分、血糖、血乳酸、血 PH值、脑疝，一并分析它们对预后的影响。单因素分析中结果有统计学意义的因素，引入非条件 logistic回归模型中进行多因素分析。结果单因素分析结果显示病人入院时间、 GCS评分、收缩压平均数、血糖、血乳酸、脑疝及收缩压标准差组间比较差异有统计学意义(均 P＜0.05)；病人年龄、血 PH值组间比较差异无统计学意义( P＞0.05)。用 logistic回归模型进行控制分析，脑疝、收缩压平均数、收缩压标准差 3个变量被保留入回归方程( P＜0.05)进一步将发生脑疝病人行单因素及 logistic回归分析，收缩压平均数、收缩压标准差 2个变量被保留入回归方程( P＜0.05)。结论，术中收缩压标准差是重度颅脑损伤病人伤后 3个月预后不良的危险因素，收缩压标准差越大，病人预后越差；收缩压平均数是影响病人伤后 3个月预后的保护因素，在一定的阈值内，收缩压平均数越高，病人预后越好。 |
| 英文摘要: |
| Objective To investigate the effect of intraoperative blood pressure variability(BPV)on the prognosis of 3 months after trauma in patients with severe traumatic brain injury(TBI).Methods The observational cross?sectional study was used to analysisthe clinical data of 87 patients with severe traumatic brain injury and craniotomy during the period from July 2014 to December2017 in Affiliated Hospital of Xuzhou Medical University.The patients were divided into good group(GOS4?5 score)and bad group(GOS1?3 score)according to the GOS prognosis score of 3 months after injury.The influence of blood pressure variability(systolicpressure standard deviation)and mean systolic pressure on prognosis were analyzed.The factors including age，onset time，GCS score， blood glucose，lactic acid，pH value，brain hernia were analyzed at the same time.Univariate analysis was used to analyze what factorswere statistically significant.And those significant factors were multivariately analyzed in the unconditional logistic regression model.Results The results of univariate analysis showed that there were statistically significant differences in onset time，GCS score，mean systolic blood pressure，blood glucose，blood lactate，cerebral hernia and systolic blood pressure standard deviation between the groups(P＜0.05).There was no statistically significant difference in age and blood pH between the groups(P＞0.05).Logistic regres? sion model was used for control analysis.Three variables of cerebral hernia，mean systolic blood pressure and standard deviation of systolic blood pressure were retained in the regression equation(P＜0.05).Conclusions The standard deviation of systolic pressurein the operation is the risk factor of poor prognosis of 3 months after trauma in severe traumatic brain injury patients.The mean of sys?tolic pressure is the protective factor affecting the prognosis of 3 months after trauma in severe traumatic brain injury patients. |
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