中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2013年
5期
301-305
,共5页
杨田军%费明明%叶文%潘爱军%刘宝
楊田軍%費明明%葉文%潘愛軍%劉寶
양전군%비명명%협문%반애군%류보
脑外伤,严重%白蛋白%血红蛋白%病死率
腦外傷,嚴重%白蛋白%血紅蛋白%病死率
뇌외상,엄중%백단백%혈홍단백%병사솔
Severe traumatic brain injury%Albumin%Hemoglobin%Mortality
目的 明确血浆白蛋白及血红蛋白(Hb)水平对单纯严重脑外伤患者预后的影响.方法 采用回顾性队列研究方法,选择安徽省立医院重症监护病房(ICU)收治的168例单纯严重脑外伤患者,分析入院3d内血浆白蛋白、Hb水平与临床预后的关系.首先计算患者入院后3d内平均白蛋白水平后,按四分位数将患者分为＜25、25～28、29 ～ 31以及≥32 g/L4组；同样根据平均Hb水平将患者分为＜90、90～99、100～109以及≥110g/L4组.用logistic回归判断各组变量对死亡的预测价值,从而明确白蛋白及Hb水平对预后的影响.结果根据入选及排除标准,最后有109例患者入选.住院期间共有32例患者(29.4％)输注浓缩红细胞,24例患者(22.0％)输注人血白蛋白.根据平均白蛋白水平分组,＜25、25 ～ 28、29 ～ 31和≥32 g/L4组患者的病死率比较差异有统计学意义[分别为85.2％(23/27)、59.3％(16/27)、32.1％(9/28)、44.4％(12/27),P=0.001]；根据Hb水平分组,＜90、90～99、100 ～ 109和≥110 g/L4组之间的病死率比较差异无统计学意义[分别为61.8％(34/55)、43.8％(7/16)、53.3％(8/15)、47.8％(11/23),P＞ 0.05].以白蛋白、格拉斯哥昏迷评分(GCS)、年龄和发病时间进行logistic回归分析显示,白蛋白水平和年龄均可影响患者的病死率,总体上随着白蛋白水平的升高,病死率下降,但白蛋白水平在≥32 g/L时其死亡风险却高于29～ 31g/L时[白蛋白29 ～ 31 g/L的相对危险度(RR)=0.070,95％可信区间(95％CI)为0.015～0.331,P=0.001；白蛋白≥32 g/L的RR=0.153,95％CI为0.035 ～ 0.663,P=0.012;年龄的RR=0.691,95％CI为0.526 ～ 0.907,P=0.008].以Hb水平、GCS、年龄和发病时间进行logistic回归分析显示,仅有GCS评分进入了回归模型(RR=0.696,95％CI为0.550 ～ 0.880,P=0.002),说明Hb水平对病死率无明显影响；随着GCS评分的升高病死率呈下降趋势.结论 单纯严重颅脑外伤患者的最佳白蛋白水平为29～ 31 g/L;Hb在90 g/L以上时,各组患者的病死率无差异.
目的 明確血漿白蛋白及血紅蛋白(Hb)水平對單純嚴重腦外傷患者預後的影響.方法 採用迴顧性隊列研究方法,選擇安徽省立醫院重癥鑑護病房(ICU)收治的168例單純嚴重腦外傷患者,分析入院3d內血漿白蛋白、Hb水平與臨床預後的關繫.首先計算患者入院後3d內平均白蛋白水平後,按四分位數將患者分為＜25、25～28、29 ～ 31以及≥32 g/L4組；同樣根據平均Hb水平將患者分為＜90、90～99、100～109以及≥110g/L4組.用logistic迴歸判斷各組變量對死亡的預測價值,從而明確白蛋白及Hb水平對預後的影響.結果根據入選及排除標準,最後有109例患者入選.住院期間共有32例患者(29.4％)輸註濃縮紅細胞,24例患者(22.0％)輸註人血白蛋白.根據平均白蛋白水平分組,＜25、25 ～ 28、29 ～ 31和≥32 g/L4組患者的病死率比較差異有統計學意義[分彆為85.2％(23/27)、59.3％(16/27)、32.1％(9/28)、44.4％(12/27),P=0.001]；根據Hb水平分組,＜90、90～99、100 ～ 109和≥110 g/L4組之間的病死率比較差異無統計學意義[分彆為61.8％(34/55)、43.8％(7/16)、53.3％(8/15)、47.8％(11/23),P＞ 0.05].以白蛋白、格拉斯哥昏迷評分(GCS)、年齡和髮病時間進行logistic迴歸分析顯示,白蛋白水平和年齡均可影響患者的病死率,總體上隨著白蛋白水平的升高,病死率下降,但白蛋白水平在≥32 g/L時其死亡風險卻高于29～ 31g/L時[白蛋白29 ～ 31 g/L的相對危險度(RR)=0.070,95％可信區間(95％CI)為0.015～0.331,P=0.001；白蛋白≥32 g/L的RR=0.153,95％CI為0.035 ～ 0.663,P=0.012;年齡的RR=0.691,95％CI為0.526 ～ 0.907,P=0.008].以Hb水平、GCS、年齡和髮病時間進行logistic迴歸分析顯示,僅有GCS評分進入瞭迴歸模型(RR=0.696,95％CI為0.550 ～ 0.880,P=0.002),說明Hb水平對病死率無明顯影響；隨著GCS評分的升高病死率呈下降趨勢.結論 單純嚴重顱腦外傷患者的最佳白蛋白水平為29～ 31 g/L;Hb在90 g/L以上時,各組患者的病死率無差異.
목적 명학혈장백단백급혈홍단백(Hb)수평대단순엄중뇌외상환자예후적영향.방법 채용회고성대렬연구방법,선택안휘성립의원중증감호병방(ICU)수치적168례단순엄중뇌외상환자,분석입원3d내혈장백단백、Hb수평여림상예후적관계.수선계산환자입원후3d내평균백단백수평후,안사분위수장환자분위＜25、25～28、29 ～ 31이급≥32 g/L4조；동양근거평균Hb수평장환자분위＜90、90～99、100～109이급≥110g/L4조.용logistic회귀판단각조변량대사망적예측개치,종이명학백단백급Hb수평대예후적영향.결과근거입선급배제표준,최후유109례환자입선.주원기간공유32례환자(29.4％)수주농축홍세포,24례환자(22.0％)수주인혈백단백.근거평균백단백수평분조,＜25、25 ～ 28、29 ～ 31화≥32 g/L4조환자적병사솔비교차이유통계학의의[분별위85.2％(23/27)、59.3％(16/27)、32.1％(9/28)、44.4％(12/27),P=0.001]；근거Hb수평분조,＜90、90～99、100 ～ 109화≥110 g/L4조지간적병사솔비교차이무통계학의의[분별위61.8％(34/55)、43.8％(7/16)、53.3％(8/15)、47.8％(11/23),P＞ 0.05].이백단백、격랍사가혼미평분(GCS)、년령화발병시간진행logistic회귀분석현시,백단백수평화년령균가영향환자적병사솔,총체상수착백단백수평적승고,병사솔하강,단백단백수평재≥32 g/L시기사망풍험각고우29～ 31g/L시[백단백29 ～ 31 g/L적상대위험도(RR)=0.070,95％가신구간(95％CI)위0.015～0.331,P=0.001；백단백≥32 g/L적RR=0.153,95％CI위0.035 ～ 0.663,P=0.012;년령적RR=0.691,95％CI위0.526 ～ 0.907,P=0.008].이Hb수평、GCS、년령화발병시간진행logistic회귀분석현시,부유GCS평분진입료회귀모형(RR=0.696,95％CI위0.550 ～ 0.880,P=0.002),설명Hb수평대병사솔무명현영향；수착GCS평분적승고병사솔정하강추세.결론 단순엄중로뇌외상환자적최가백단백수평위29～ 31 g/L;Hb재90 g/L이상시,각조환자적병사솔무차이.
Objective To evaluate the best level of albumin and hemoglobin for the patients with uncomplicated severe traumatic brain injury (TBI).Methods A retrospective cohort study was conducted.One hundred and sixty-eight patients with uncomplicated severe TBI admitted to intensive care unit (ICU) of Anhui Provincial Hospital were enrolled.The relationship between albumin and hemoglobin level within 3 days after admission and prognosis was analyzed.Mean 3-day albumin level was obtained,and then the patients were divided into ＜25,25-28,29-31 and ≥32 g/L groups according to quartiles based on mean albumin,and also were divided into ＜90,90-99,100-109 and ≥ 110 g/L groups according to the mean hemoglobin concentration.Multivariable log-binomial regression was used to model the association between mean albumin and hemoglobin concentration and prognosis.Results One hundred and nine patients were enrolled based on inclusion/exclusion criteria.Among them,32 patients (29.4％) received a red blood cell (RBC) transfusion,and 24 patients (22.0％) were given albumin treatment.According to the average level of albumin,there were significant differences in mortality among ＜25,25-28,29-31 and ≥32 g/L groups [85.2％(23/27),59.3％(16/27),32.1％(9/28),44.4％(12/27),respectively,P=0.001].According to the hemoglobin level,there was no significant difference in mortality rate among ＜90,90-99,100-109 and ≥ 110 g/L groups [61.8％(34/55),43.8％(7/16),53.3％(8/15),47.8％(11/23),respectively,P＞0.05].When using the albumin level,Glasgow coma score (GCS),age and time of onset for logistic analysis,albumin level and age had influence on the mortality of patients,and mortality rate was generally decreased with an increase in albumin.But when the levels of albumin was ≥ 32 g/L,the risk of death was higher than in the 29-31 g/L group[relative risk (RR) of albumin 29-31 g/L=0.070,95％ confidence interval (95％CI) 0.015-0.331,P=0.001 ; RR of albumin ≥32 g/L=0.153,95％CI 0.035-0.663,P=0.012; RR of age=0.691,95％CI0.526-0.907,P=0.008].When the hemoglobin level,GCS,age and time of onset were used for logistic regression analysis,only GCS entered the regression model (RR=0.696,95％ CI 0.550-0.880,P=0.002),illustrating that the hemoglobin level had no significant iufluence on mortality,and mortality rate declined with an increase in GCS.Conclusions The most favorable level of albumin for uncomplicated severe traumatic brain injury is 29-31 g/L.There is no difference in mortality rate when hemoglobin ＞90 g/L.
