|
|
|
|
|
| Research of clinical features and prognostic factors in patients with severe traumatic brain injury with good early prognosis |
| Feng Ai-ping, Jiang Tao, Liu Lun-bo, Huang Qi-jun, Du Chen |
| Department of Neurosurgery, the Second People’s Hospital of Deyang City, Deyang 618000, China |
|
|
|
|
Abstract Objective To evaluate the clinical features of the patients with severe traumatic brain injury (TBI) with good early prognosis and the factors that affect the early prognosis of patients. The time characteristics of early neurological recovery in patients were analyzed. Methods Clinical data of 172 patients who recovered well and the Glasgow outcome scale (GOS) score was 4 points (moderately disabled group, n=90) or 5 points(good recovery group, n=82) after 6 months of treatment in our neurosurgical intensive care unit (ICU) between January 2014 and December 2018 were included. The clinical indicators of patients with moderate disability and those with good recovery were compared. Twenty-four patients with severe TBI who were not included in the study but discontinued life-sustaining treatment at the same time (suspended life-sustaining treatment group,n=24) were included. The clinical data between the patients in the life-sustaining treatment group and the patients with good prognosis (GCS score 4～5, n=172) were compared. The effect of discontinuation of life-sustaining treatment on clinical indicators of patients were evaluated. The time distribution characteristics of early neurological recovery in patients were analyzed. Patients were divided into 0～7 days group (n=114), 8～14 days group (n=22), 15～30 days group (n=20) and 30～180 days (n=16) group according to the time of early neurological recovery. The clinical data of each group of patients were compared. The factors that influenced the timing of early neurological recovery in patients were evaluated. Pearson correlation analysis was used to evaluate the correlation between the 6-month GOS score and the GOS scores of patients discharged, treated for 1 month, and treated for 3 months. Results The average age of patients were (28.8±11.3) years old. The main cause of injury was car injury (58.1%, 100/172). Compared with the moderate disabled group, the GCS score of the patients in the good recovery group was significantly increased (t=2.480, P=0.014), and the incidence of pupil divergence was significantly lower at admission (χ2=6.073, P=0.014), ICU hospitalization time (t=3.563, P<0.001) and total hospital stay (t=4.989, P<0.001) were significantly reduced. Compared with patients with severe TBI with a good prognosis (n=172), the GCS score (t=7.386, P<0.001) was significantly lower in patients with discontinuation of life-sustaining therapy (n=24), and the incidence of bilateral pupillary non-response (χ2=8.131, P=0.004) was significantly improved, and the proportion of patients admitted to the Marshall CT grade VI (χ2=9.102, P=0.003) was significantly improved. Most (66.3%, 114/172) patients were able to complete the command movement within 1 week after injury, with the highest recovery rate on 1 day(26.7%, 46/172). The GOS score at 6 months of onset was significantly correlated with the GOS score at 1 month (r=0.336, P<0.001) and the GOS score at 3 months (r=0.562, P<0.001). Conclusion In the final 2 weeks of treatment in patients with severe TBI, 20.9% of patients are able to complete the mandatory action ［6 points for motor response Glasgow coma scale(mGCS)］. Although these patients experienced long-term intracranial pressure（ICP） monitoring and neuromuscular blockade, they are still likely to have a good prognosis. Do not prematurely stop life-sustaining treatment in patients with severe TBI.
|
|
|
| About author:: Feng Ai-ping, E-mail： fengaipingdy@sina.com |
|
|
|
| ［1］中华医学会神经外科学分会,中国神经外科重症管理协作组. 中国重型颅脑创伤早期康复管理专家共识(2017)［J］. 中华医学杂志, 2017, 97(21): 1615-1623.
［2］Wauters L, Marquardt TP. Disorders of emotional communication in traumatic brain injury［J］. Semin Speech Lang, 2019, 40(1): 13-26.
［3］游文栋, 温良, 杨小锋. 颅脑创伤后意识障碍患者脑功能评估的研究进展［J］. 中华创伤杂志, 2017, 33(11): 1049-1052.
［4］Turgeon AF, Lauzier F, Simard JF, et al. Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a canadian multicentre cohort study［J］. CMAJ, 2011, 183(14): 1581-1588.
［5］中国神经科学学会神经损伤与修复分会. 脑损伤神经功能损害与修复专家共识［J］. 中华神经创伤外科电子杂志, 2016, 2(2): 100-104.
［6］Izzy S, Compton R, Carandang R, et al. Self-fulfilling prophecies through withdrawal of care: do they exist in traumatic brain injury, too［J］. Neurocrit Care, 2013, 19(3):347-363.
［7］吴彩军, 李春盛. 创伤早期液体复苏的研究进展［J］. 中华急诊医学杂志, 2015, 24(5): 569-573.
［8］孙奥, 李文臣, 陈勃, 等. 颅脑创伤后脑死亡判定辅助技术的研究进展［J］. 中华神经创伤外科电子杂志, 2018, 4(6): 371-373.
［9］Nazari R, Pahlevan Sharif S, Allen KA, et al. Behavioral pain indicators in patients with traumatic brain injury admitted to an intensive care unit［J］. J Caring Sci, 2018, 7(4): 197-203.
［10］Rassovsky Y, Levi Y, Agranov E, et al. Predicting long-term outcome following traumatic brain injury (TBI) ［J］. J Clin Exp Neuropsychol, 2015, 37(4): 354-366.
［11］Yucel N, Ozturk Demir T, Derya S, et al. Potential risk factors for in-hospital mortality in patients with moderate-to-severe blunt multiple trauma who survive initial resuscitation［J］. Emerg Med Int, 2018, 2018: 6 461 072.
［12］罗才奎, 孟亮, 王跃飞, 等. 急性重型颅脑损伤患者血糖水平对预后的影响［J］. 中华内分泌外科杂志, 2018, 12(4): 318-321.
［13］Yuh EL, Mukherjee P, Lingsma HF, et al. Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury［J］. Ann Neurol, 2013, 73(2): 224-235. |
|
|
|
Address: 1 North 2nd Street,
Zhongguancun, 
