CAJ | 학술논문

目的动态监测颅脑创伤患者入院后3d内血碱剩余(BE)水平的变化,评估血BE水平对预后的影响.方法选取颅脑创伤患者56例,监测入院后3d内动脉血BE水平,按入院即刻格拉斯哥昏迷量表(GCS)评分将患者分为轻型(13 ～ 15分)组15例、中型(9～ 12分)组22例、重型(3～8分)组19例,按预后分为死亡组14例与存活组42例,以入院后3d内血BE水平分为高BE(≥-8 mmol/L)组35例和低BE(＜-8 mmol/L)组21例,比较评估血BE水平与患者病情严重程度、预后的关系.结果轻、中、重型组患者入院后1、2、3d血BE水平较入院即刻出现不同程度的升高,轻型组[(-3.02±0.21)mmol/L]、重型组[(-9.64±1.19)mmol/L]分别与中型组[(-8.49±1.44)mmol/L]比较差异有统计学意义(P＜0.01)；死亡组患者入院即刻、入院后1、2、3d血BE水平均显著低于存活组[(-11.97±2.13)mmol/L比(-6.29±1.16) mmol/L,(-9.84±1.33)mmol/L比(-4.89±1.78) mmol/L,(-8.78±2.01)mmol/L比(-3.61±1.43)mmol/L,(-7.84±1.42)mmol/L比(-3.10±0.98) mmol/L](P＜ 0.01)；低BE组入院即刻急性生理和慢性健康状况Ⅱ评分、病死率均高于高BE组[(24.84±3.68)分比(16.27±2.21)分；52.4％(11/21)比8.6％(3/35)] (P＜ 0.01),入院即刻GCS评分低于高BE组[(7.56±3.09)分比(1 0.51±2.43)分](P＜0.01).结论早期动态监测血BE水平是评价颅脑创伤患者治疗效果及预测预后的简单而有效的指标,值得临床推广应用.
목적 동태감측로뇌창상환자입원후3d내혈감잉여(BE)수평적변화,평고혈BE수평대예후적영향.방법 선취로뇌창상환자56례,감측입원후3d내동맥혈BE수평,안입원즉각격랍사가혼미량표(GCS)평분장환자분위경형(13 ～ 15분)조15례、중형(9～ 12분)조22례、중형(3～8분)조19례,안예후분위사망조14례여존활조42례,이입원후3d내혈BE수평분위고BE(≥-8 mmol/L)조35례화저BE(＜-8 mmol/L)조21례,비교평고혈BE수평여환자병정엄중정도、예후적관계.결과 경、중、중형조환자입원후1、2、3d혈BE수평교입원즉각출현불동정도적승고,경형조[(-3.02±0.21)mmol/L]、중형조[(-9.64±1.19)mmol/L]분별여중형조[(-8.49±1.44)mmol/L]비교차이유통계학의의(P＜0.01)；사망조환자입원즉각、입원후1、2、3d혈BE수평균현저저우존활조[(-11.97±2.13)mmol/L비(-6.29±1.16) mmol/L,(-9.84±1.33)mmol/L비(-4.89±1.78) mmol/L,(-8.78±2.01)mmol/L비(-3.61±1.43)mmol/L,(-7.84±1.42)mmol/L비(-3.10±0.98) mmol/L](P＜ 0.01)；저BE조입원즉각급성생리화만성건강상황Ⅱ평분、병사솔균고우고BE조[(24.84±3.68)분비(16.27±2.21)분；52.4％(11/21)비8.6％(3/35)] (P＜ 0.01),입원즉각GCS평분저우고BE조[(7.56±3.09)분비(1 0.51±2.43)분](P＜0.01).결론 조기동태감측혈BE수평시평개로뇌창상환자치료효과급예측예후적간단이유효적지표,치득림상추엄응용.
Objective To dynamically monitor the base excess(BE) in traumatic brain injury(TBI) patients within 3 d after admission,and to assess the impact of the early BE on prognosis.Methods Blood BE was monitored for 3 d in 56 TBI patients.Patients were classified into mild group(15 patients),moderate group (22 patients) and severe group (19 patients) according to the scores of Glasgow coma scale(GCS).Patients were classified into survival group(42 patients) and dead group(14 patients) according to prognosis.Patients were classified into high BE group (35 patients,BE≥-8 mmol/L) and low BE group (21 patients,BE ＜-8 mmol/L).The relations among BE,degree of injury and prognosis were analyzed.Results The level of BE in mild group,moderate group and severe group was increased after treatment for 1,2,3 d than that before treatment.The level of BE was consistent with the degree of injury [mild group:(-3.02 ± 0.21)mmol/L; moderate group:(-8.49 ± 1.44) mmol/L;severe group:(-9.64 ± 1.19) mmol/L].The level of BE in mild group and severe group had significant difference than that in moderate group (P＜ 0.01).The level of BE in dead group before treatment and after treatment for 1,2,3 d was significantly lower than that in survival group [(-11.97 ±2.13) mmol/L vs.(-6.29 ± 1.16) mmol/L,(-9.84 ± 1.33) mmol/L vs.(-4.89 ± 1.78)mmol/L,(-8.78 ± 2.01) mmol/L vs.(-3.61 ± 1.43) mmol/L,(-7.84 ± 1.42) mmol/L vs.(-3.10 ±0.98)mmol/L] (P ＜0.01).The scores of APACHE Ⅱ before treatment and fatality rate in low BE group were significantly higher than those in high BE group [(24.84 ± 3.68) scores vs.(16.27 ± 2.21) scores,52.4％ (11/21) vs.8.6％(3/35)] (P ＜ 0.01).The scores of GCS before treatment in low BE group was significantly higher than that in high BE group [(7.56 ± 3.09) scores vs.(10.51 ± 2.43) scores](P ＜ 0.01).Conclusion The level of early BE is a good factor on evaluating the condition and prognosis in TBI patients.