颅脑损伤急诊处理多因素与预后相关性分析.

Objective To study the clinical factors that affect the prognosis of patients with traumatic brain injury (TBI) and provide reference for improving the prognosis of TBI patients. Methods The clinical data of 220 TBI patients underwent surgery from January 2018 to December 2022 in Department of Neurosurgery, the Affiliated Lianyungang Hospital of Xuzhou Medical University were analyzed retrospectively. According to the Glasgow outcome score (GOS), they were divided into a good prognosis group (GOS≥4 points) and a poor prognosis group (GOS ≤ 3 points) . Univariate and multivariate logistic regression analysis were used to analyze the risk factors of poor prognosis in patients with TBI surgery. R software was used to construct a column chart model to predict the risk of poor prognosis in patients underwent craniocerebral injury surgery, and the calibration curve and decision analysis curve were used to verify the predictive performance of the model. Results Univariate analysis showed a significant correlation between age, GCS score, time from injury to emergency room, surgery time window, blood glucose concentration, D-dimer concentration, midline shift distance and bleeding site (P＜0. 05-0. 001) . The results of multivariate analysis showed that age ≥ 60 years (OR=2. 048, P=0. 037), GCS score ≤ 8 points (OR=2. 240, P=0. 037), surgery time window (OR=1. 239, P=0. 006), blood glucose concentration ≥ 8. 8 mmol/L (OR=2. 165, P=0. 027), D-dimer concentration (OR=1. 636, P=0. 002), midline shift distance＞1 cm (OR=5, 467, P＜0. 001) and subdural hemorrhage (OR=3. 031, P=0. 003) were independent risk factors in patients undergoing TBI surgery. Building a column chart model based on the above risk factors, the area under the curve of the model was 0. 838 (95％CI=0. 785-0. 891) . The calibration curve basically coincided with the ideal curve. Conclusions Age≥60 years old, GCS score≤8 points, surgery time window ≥6. 9 hours, blood glucose concentration ≥8. 8 mmol/L, D-dimer concentration ≥ 11 590 ng/mL, midline shift distance＞1 cm and subdural hemorrhage are influencing factors for poor prognosis in TBI surgery patients. TBI patients are transported to the hospital within 3. 8 hours after injury and undergo craniotomy within 6. 9 hours, resulting in a low incidence of poor prognosis. The column chart model constructed based on the above risk factors has certain predictive performance and clinical application value for the prognosis evaluation of TBI patients. [ABSTRACT FROM AUTHOR]