CAJ | 학술논문

目的研究热负荷在预测创伤性颅脑损伤(TBI)患者预后中的临床价值.方法回顾性收集苏州大学附属第一医院急诊病房及重症监护室2010年11月至2012年10月收治的创伤性颅脑损伤患者共355例,格拉斯哥昏迷评分(GCS)≤14分,随访伤后6个月的格拉斯哥结局评分(GOS).根据患者伤后6个月GOS评分将其分为两组:4～5分为预后良好组,1～3分为预后不良组,对相关临床指标进行统计描述、Logistic回归分析、Spearman相关分析及ROC曲线分析.结果 GOS从5分到2分,患者的热负荷水平呈现持续升高表现,1分组热负荷水平反而明显下降.两组患者在平均年龄、瞳孔反应、GCS评分以及热负荷差异具有统计学意义(P＜0.05).预后不良组与预后良好组比较表现为平均年龄大(P=0.000)、瞳孔反应差(P=0.000)、GCS低(P=0.000)、热负荷水平高(P=0.000).单变量Logistic回归分析同样提示:年龄、GCS、瞳孔反应、热负荷与患者预后不良有关(P =0.000),其中热负荷的OR值为1.166(95％ CI:1.117～1.217).进一步将热负荷与年龄、GCS、瞳孔反应三个预后不良的独立预测因素纳入多变量Logistic 回归模型,得到热负荷调整后的OR值为1.098(95％ CI:1.031～1.169,P=0.003).ROC曲线分析得到热负荷对应的AUC=0.713 (95％ CI:0.663～0.760).相关分析显示热负荷与GOS评分之间呈现负相关,(r=-0.376,95％CI:-0.462～-0.283,P=0.000).结论热负荷可以作为TBI患者预后不良的独立预测因素,TBI患者发病早期高水平热负荷将增加预后不良风险.
목적 연구열부하재예측창상성로뇌손상(TBI)환자예후중적림상개치.방법 회고성수집소주대학부속제일의원급진병방급중증감호실2010년11월지2012년10월수치적창상성로뇌손상환자공355례,격랍사가혼미평분(GCS)≤14분,수방상후6개월적격랍사가결국평분(GOS).근거환자상후6개월GOS평분장기분위량조:4～5분위예후량호조,1～3분위예후불량조,대상관림상지표진행통계묘술、Logistic회귀분석、Spearman상관분석급ROC곡선분석.결과 GOS종5분도2분,환자적열부하수평정현지속승고표현,1분조열부하수평반이명현하강.량조환자재평균년령、동공반응、GCS평분이급열부하차이구유통계학의의(P＜0.05).예후불량조여예후량호조비교표현위평균년령대(P=0.000)、동공반응차(P=0.000)、GCS저(P=0.000)、열부하수평고(P=0.000).단변량Logistic회귀분석동양제시:년령、GCS、동공반응、열부하여환자예후불량유관(P =0.000),기중열부하적OR치위1.166(95％ CI:1.117～1.217).진일보장열부하여년령、GCS、동공반응삼개예후불량적독립예측인소납입다변량Logistic 회귀모형,득도열부하조정후적OR치위1.098(95％ CI:1.031～1.169,P=0.003).ROC곡선분석득도열부하대응적AUC=0.713 (95％ CI:0.663～0.760).상관분석현시열부하여GOS평분지간정현부상관,(r=-0.376,95％CI:-0.462～-0.283,P=0.000).결론 열부하가이작위TBI환자예후불량적독립예측인소,TBI환자발병조기고수평열부하장증가예후불량풍험.
Objective To investigate the prognostic value of fever burden in traumatic brain injury (TBI) patients.Methods A retrospective analysis of 355 TBI patients admitted to the emergency department and intensive care unit from November 2010 to October 2012 was performed,and the Glasgow outcome scale (GOS) was followed-up 6 months after the injury.The patients were divided into two groups according to the GOS:good outcome group (4 to 5) and poor outcome group (1 to 3).Relevant clinical findings were studied by statistical description,logistic regression analysis,Spearman correlation analysis and ROC curve analysis.Results Fever burden level was continuously increased with the decrease of GOS from score 5 to 2,except for score 1 of GOS,which was corresponding to a significant lower fever burden.There were significant differences in age,pupil reactivity,Glasgow coma scale (GCS) and fever burden between two groups (P ＜ 0.05).Compared to the good outcome group,the poor outcome group was featured with more advanced average age (P =0.000),poorer pupil reactivity (P =0.000),lower GCS score (P =0.000) and higher fever burden level (P =0.000).Univariate logistic regression analysis suggested that age,GCS,pupil reactivity and fever burden level (OR 1.166,95％ CI:1.117-1.217) were associatedwith poor outcome.The fever burden level and the other independent prognostic predictors as age,GCS and pupil reactivity were further included in the multivariate logistic regression model,and the adjusted OR of fever burden level was 1.098 (95％ CI:1.031-1.169,P =0.003).ROC curve analysis showed the respective AUC for fever burden was 0.713 (95％ CI:0.663-0.760).The relevant analysis revealed a significant negative correlation between the fever burden and the GOS score (r =-0.376,95％ CI:-0.462--0.283,P =0.000).Conclusions Fever burden can be considered as an independent predictor of poor outcome of patients with TBI.The TBI patients with early onset of high levels of fever burden will have increased poor outcome risk.