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··陈华文 祝伟 李树生 郑智 【】 。 150。 38.7%,、、、(P0.01)。 、、、、。【】;;RiskfactorsofseverecraniocerebralinjuryCHENHuawen,ZHUWei,LIShusheng,ZHENGZhi.IntensiveCareUnit,TongjiHospitalAffiliatedtoTongjiMedicalCollege,HuazhongUniversityofScienceandTechnology,Wuhan430030,China【Abstract】Objective Toexploretheriskfactorsofseverecraniocerebralinjury.Methods Onehundredandfiftypatientswithseverecraniocerebralinjurywerestudiedretrospectively.Allthepatientsweredividedintogroupsaccordingtodifferentlevelsofserumsugarandsodium,whethercomplicatedwithextracerebralorganinjury,earlyhypotensionorearlyhypoxemia.Thechi-squaretestwasusedtoexaminethemortalitybetweenthesegroups.Results Thetotalmortalityofseverecraniocerebralinjurywas38.7%.Patientscomplicatedwithextracerebralorganinjury,earlyhypotension,earlyhypoxemia,hyperglycemia,andhypernatremiahadahighermortalitythanothers(P0.01).Conclusion Themainriskfactorssevercraniocerebralinjuryareextracerebralorganinjury,earlyhypotension,earlyhypoxemia,hyperglycemiaandhypematremia.【Keywords】Severecraniocerebralinjury;Mortality;Riskfactors:430020 ,ICU ,,,。150,。1 1.1 2000820048150,,、、、、、、、、、、、、、、、、、GCS、APACHEⅡ、、。1.2 (1) GCS8;(2) 《》145mmoL/L;(3) 6.1mmol/L;(4) 90mmHg;(5) PaO260mmHg。1.3 SPSS10.0,χ2。2 98(65.3%),52(34.7%)。58,38.7%,32,26,4~78。:102(68.0%),40(26.7%),8(5.3%),72(48%),37(24.7%),38·216·20063153ChinJEmergMed,March2006,Vol.15,No.3(25.3%),45(30.0%)。、、,35(23.3%),28(18.7%),17(11.3%),138。,1。,2。,,、、、,3。1 Table1 Therelationbetweenhyperglycemiaandmortality(mmol/L)(n)(n)(%)6.1~11.120735.0*11.1~18.1361747.2*18.1~25.1161487.5 ≥25.110990.0 :≥25.1mmol/L,*P0.052 Table2 Therelationbetweenhypernatremiaandmortality(mmol/L)(n)(n)(%)146~16112541.7161~176171376.5*≥17699100■ :146~161mmol/L,*P0.05;146~161mmol/L,■P0.013 Table3 Theriskfactorsofseverecraniocerebral(n)(n)(%)χ2P 844754.0226.530.01681116.18 382771.0522.510.011123127.68 774659.7429.630.01731216.44 613963.9327.680.01891921.35704361.4328.670.01801518.753 3.1 ,,,(P0.01)。,,18mmol/L,87.5%,,[1]。,,-,;,,,、、,[2]。,,,[1]。,,,,,、、。,、、。3.2 :(1) 、、,ADH[3]。(2) ,、、。(3) ,,,,。,、,,,。,,·217·20063153ChinJEmergMed,March2006,Vol.15,No.3176mmol/L。,。,,,,[4]。3.3 ,、、[5]。Arthur[5],17%33%。、、,、,,,,,。3.4 、、,,、。、。,、、、,。,,。,,,,,。[1],,.[J].,2003,2(1):25-26.QiJian,YuDingyong,TangWenguo.Therelationshipbetweenhyperglycemiaandprognosisinpatientswithseverheadinjury[J].ChinJNeuroMed,2003,2(1):25-26.[2],,.[J].,1996,8(2):70-72.ZhangSai,YangShuyuan,WangMinglu.Changesandsignificanceofbloodcatecholamineandglucoseinpatientswithacuteheadinjury[J].ChinJCriticalandEmergency,1996,8(2):70-72.[3],.[J].,2004,20(5):434-435.XuJiguang,LuJunlan.Effectofhypernatremiaonseverheadinjurypatients[J].ClinicalMedicineofChina,2004,20(5):434-435.[4],.[J].,2004,9(3):220-221.LiuYibing,ZhuYunfa.Applicationofhemodialysistotreathypernatremiaaftercraniotomy[J].ChinJNeurosurg,2004,9(3):220-221.[5]ArthurE,EugenF,DonaldF.Careofinjuredpatientsinthefield,duringtransport,andintheemergencydepartment[M].MultipleOrganFailure:pathophysiolgy,prevention,andtherapy.NewYork:Springer,2000:244.(:2005-10-17)(:)··《》2006(15) 《》、,,、、,。《》、、、、、、、、,,,,。《》()、《(CA)》、《(EM)》、《》、《》、《》、《》、《CMCC》、《()》、《》。《》,A4,96,。200610.00,120.00。,32-41。。:88,:310009;:0571-87783951,:0571-87783647。E-mail:jzyx@mail.hz.zj.cn《》·218·20063153ChinJEmergMed,March2006,Vol.15,No.3
本文标题:重型颅脑损伤死亡危险因素的分析
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