目的：探讨格拉斯哥昏迷量表评分（Glasgow coma scale score, GCS）联合鹿特丹（Rotterdam）CT评分及中重度创伤性脑损伤（traumatic brain injury,TBI）并发症对其预后的预测价值。方法：回顾性收集2020年1月—2022年12月本单位收治的144例中重度TBI患者一般资料、GCS评分、Rotterdam CT评分及其并发症情况。随访6个月并根据格拉斯哥预后量表（Glasgow outcome scale,GOS）评分,采用单因素及多因素Logistic回归分析以确定中重度创伤性脑损伤患者预后不良的独立危险因素。绘制受试者工作特征曲线（ROC曲线）并评价GCS、Rotterdam CT、中重度TBI患者并发症单独及联合对其预后不良的预测价值。结果：预后良好组102例,预后不良组42例,预后良好组出院GCS评分高于预后不良组,Rotterdam CT评分则低于预后不良组。多元Logistic回归分析显示GCS评分、RotterdamCT评分、并发症再出血的OR值分别为0.8（95%CI：0.68~0.92）、1.63（95%CI：1.14~2.34）、14.58（95%CI：2.29~92.69）,是中重度TBI患者预后不良的独立预测因素。ROC曲线分析显示,GCS评分、Rotterdam CT评分、并发再出血对中重度TBI患者的预后不良均有预测价值,三者联合预测的AUC最大,为0.850（95% CI：0.771~0.929）,敏感度为78.57%、特异度为83.33%。结论：GCS、Rotterdam CT评分及并发症再出血的组合对预测中重度TBI患者的预后效果最优。
Abstract
Objective To explore the predictive value of Glasgow Coma Scale score (GCS), Rotterdam CT score and complications of moderate-to-severe traumatic brain injury (TBI) for its prognosis. Methods A retrospective collection was made of 144 patients with moderate-to-severe TBI admitted to our unit from January 2020 to December 2022. General information, GCS scores, Rotterdam CT scores and their complication conditions of the patients were collected. After a 6-month follow-up, according to the Glasgow Outcome Scale (GOS). Univariate and multivariate Logistic regression analyses were used to determine the independent risk factors for poor prognosis in patients with moderate-to-severe TBI. Receiver operating characteristic curves (ROC curves) were drawn and the predictive values of GCS, Rotterdam CT, complications in patients with moderate-to-severe TBI alone and in combination for poor prognosis were evaluated. Results There were 102 cases in the good - prognosis group and 42 cases in the poor-prognosis group. The discharge GCS score of the good - prognosis group was higher than that of the poor-prognosis group, while the Rotterdam CT score was lower than that of the poor-prognosis group. Multivariate Logistic regression analysis showed that the OR values of GCS score, Rotterdam CT score and complication of rebleeding were 0.8 (95%CI: 0.68-0.92), 1.63 (95%CI: 1.14-2.34)and14.58 (95%CI: 2.29-92.69) respectively, which were independent predictors of poor prognosis in patients with moderate-to-severe TBI. ROC curve analysis showed that GCS score, Rotterdam CT score and concurrent rebleeding all had predictive values for poor prognosis in patients with moderate-to-severe TBI. The combination of the three had the largest AUC, which was 0.850 (95%CI: 0.771-0.929), with a sensitivity of 78.57% and a specificity of 83.33%. Conclusion The combination of GCS, Rotterdam CT score and complication of rebleeding has the best effect on predicting the prognosis of patients with moderate -to-severe TBI.
关键词
创伤性颅脑损伤 /
格拉斯哥昏迷评分 /
鹿特丹CT评分 /
并发症 /
格拉斯哥预后评分
Key words
traumatic brain injury /
Glasgow coma scale /
Rotterdam CT score /
complications /
Glasgow outcome scale
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基金
湖南省卫生健康高层次人才重大科研专项“公众急救科普‘湖南模式’实及效果的循证评价”（R2023072）; 2022年湖南省财政厅科研项目“老年心血管疾病患者院前急救预警响应模式的构建研究”（湘财教指〔2022〕75号）; 湖南省财政厅科研项目“于一键呼救的心脑血管病整体联动智慧急救模式构建研究”（湘财教指〔2021〕59号）
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