中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
2期
6-8
,共3页
谢江宁%谢正兴%许慧中%蔡华忠%常志英%丁德群%尹其翔%梁亚鹏%王存祖%陈冬云%王笃前%樊永忠
謝江寧%謝正興%許慧中%蔡華忠%常誌英%丁德群%尹其翔%樑亞鵬%王存祖%陳鼕雲%王篤前%樊永忠
사강저%사정흥%허혜중%채화충%상지영%정덕군%윤기상%량아붕%왕존조%진동운%왕독전%번영충
颅脑损伤%急诊室,医院%预后
顱腦損傷%急診室,醫院%預後
로뇌손상%급진실,의원%예후
Craniocerebral trauma%Emergency service,hospital%Prognosis
目的 分析急诊室救治措施与重型颅脑损伤患者预后之间的关系,为规范急诊室救治措施提供依据.方法 回顾性分析重型颅脑损伤患者的出院病历,统计急诊室救治措施,包括气管插管、给氧、体液复苏、使用甘露醇等.患者到达神经外科ICU时的收缩压及脉搏血氧饱和度.预后指标包括住ICU时间和ICU死亡情况,出院时及伤后第6个月的Glasgow预后量表(GOS)分级.结果 共140例重型颅脑损伤患者,65例(46.4％)在ICU治疗期间死亡,其中行气管插管者病死率为65.0％(39/60),未行气管插管者为32.5％(26/80),差异有统计学意义(P＜0.01)；是否体液复苏和使用甘露醇者病死率分别为44.7％(46/403)、51.4％(19/37)和49.2％(31/63)、44.2％(34/77),差异均无统计学意义(P＞0.05).在住ICU时间方面,上述三种救治措施实施与否差异均无统计学意义(P＞0.05).在出院时和伤后第6个月COS分级方面,行气管插管者GOS分级4、5级所占比例分别为8.3％(5/60)和25.0％(15/60),而未行气管插管者分别为27.5％(22/80)和52.5％(42/80),差异有统计学意义(P＜0.01),而在体液复苏和使用甘露醇方面差异均无统计学意义(P＞0.05).结论 重型颅脑损伤患者在急诊室救治过程中应该慎重选择气管插管,可以不给予体液复苏和甘露醇.
目的 分析急診室救治措施與重型顱腦損傷患者預後之間的關繫,為規範急診室救治措施提供依據.方法 迴顧性分析重型顱腦損傷患者的齣院病歷,統計急診室救治措施,包括氣管插管、給氧、體液複囌、使用甘露醇等.患者到達神經外科ICU時的收縮壓及脈搏血氧飽和度.預後指標包括住ICU時間和ICU死亡情況,齣院時及傷後第6箇月的Glasgow預後量錶(GOS)分級.結果 共140例重型顱腦損傷患者,65例(46.4％)在ICU治療期間死亡,其中行氣管插管者病死率為65.0％(39/60),未行氣管插管者為32.5％(26/80),差異有統計學意義(P＜0.01)；是否體液複囌和使用甘露醇者病死率分彆為44.7％(46/403)、51.4％(19/37)和49.2％(31/63)、44.2％(34/77),差異均無統計學意義(P＞0.05).在住ICU時間方麵,上述三種救治措施實施與否差異均無統計學意義(P＞0.05).在齣院時和傷後第6箇月COS分級方麵,行氣管插管者GOS分級4、5級所佔比例分彆為8.3％(5/60)和25.0％(15/60),而未行氣管插管者分彆為27.5％(22/80)和52.5％(42/80),差異有統計學意義(P＜0.01),而在體液複囌和使用甘露醇方麵差異均無統計學意義(P＞0.05).結論 重型顱腦損傷患者在急診室救治過程中應該慎重選擇氣管插管,可以不給予體液複囌和甘露醇.
목적 분석급진실구치조시여중형로뇌손상환자예후지간적관계,위규범급진실구치조시제공의거.방법 회고성분석중형로뇌손상환자적출원병력,통계급진실구치조시,포괄기관삽관、급양、체액복소、사용감로순등.환자도체신경외과ICU시적수축압급맥박혈양포화도.예후지표포괄주ICU시간화ICU사망정황,출원시급상후제6개월적Glasgow예후량표(GOS)분급.결과 공140례중형로뇌손상환자,65례(46.4％)재ICU치료기간사망,기중행기관삽관자병사솔위65.0％(39/60),미행기관삽관자위32.5％(26/80),차이유통계학의의(P＜0.01)；시부체액복소화사용감로순자병사솔분별위44.7％(46/403)、51.4％(19/37)화49.2％(31/63)、44.2％(34/77),차이균무통계학의의(P＞0.05).재주ICU시간방면,상술삼충구치조시실시여부차이균무통계학의의(P＞0.05).재출원시화상후제6개월COS분급방면,행기관삽관자GOS분급4、5급소점비례분별위8.3％(5/60)화25.0％(15/60),이미행기관삽관자분별위27.5％(22/80)화52.5％(42/80),차이유통계학의의(P＜0.01),이재체액복소화사용감로순방면차이균무통계학의의(P＞0.05).결론 중형로뇌손상환자재급진실구치과정중응해신중선택기관삽관,가이불급여체액복소화감로순.
Objective To assess the influence between managements in emergency room(ER) andoutcome of severe traumatic brain injury (TBI),in order to provide inference for treatment.Methods A retrospective analysis was performed in severe TBI patients and recorded next indexes.(1) The managements in ER,including endotracheal intubation and oxygenation,fluid resuscitation,and mannitol intake.(2) The vital signs arriving at ICU,including systolic pressure and blood oxygen saturation.(3) Prognostic indicators including inhospital mortality and days during ICU,the scores of Glasgow outcome scale (GOS) at discharge and 6 months after injury.Results In 140 severe TBI patients,65 patients (46.4％) died during ICU.The mortality of patients with endotracheal intubation [65.0％ (39/60)] was significantly higher than that without endotracheal intubation [32.5％(26/80)](P＜ 0.01).The mortality in whether fluid resuscitation and using mannitol had no significant difference [44.7％ (46/103) vs.51.4％ (19/37),49.2％ (31/63) vs.44.2％ (34/77)] (P ＞0.05).In days during ICU,there was no significant difference among the three treatment measures (P＞ 0.05).In GOS grade at discharge and 6 months after injury,the proportion of 4 and 5 grade were 8.3％ (5/60) and 25.0％ (15/60) in patients with endotracheal intubation,while 27.5％ (22/80) and 52.5％ (42/80) in patients without endotraeheal intubation (P ＜ 0.01).In fluid resuscitation and using mannitol patients,there were no significant difference(P ＞ 0.05).Conclusion Treating severe TBI patients in ER,endotracheal intubation should be carefully chosen,fluid resuscitation and mannitol may not be given.
