女性颅脑创伤患者的临床因素分析
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摘要
目的研究女性颅脑创伤(TBI)患者的临床因素,为优化女性TBI的诊断与治疗提供依据。方法回顾性分析天津医科大学总医院神经外科2011年1月—2016年12月收治的2 368例TBI患者的临床资料。分析女性TBI患者的临床特点及其出院时格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分的影响因素。结果女性TBI患者例数约为男性的1/3。与男性TBI患者相比,女性患者中开放伤和多发伤者更少,老年(≥65岁)患者的比例明显增加。男女TBI的首要伤因均为交通伤,但≥75岁女性TBI患者的首要受伤原因是跌倒。女性TBI患者中,在伤后≤6 h即入院者更多,入院时昏迷程度较男性患者轻;但总体上女性与男性TBI患者的病死率的差异无统计学意义(P> 0. 05)。单因素分析结果表明,年龄<65岁、受伤至入院时间≤6 h以及入院时GCS评分较低,可能是治疗后女性患者出院时GCS评分改善的保护因素(均P <0. 05)。多因素分析显示,年龄(OR=0. 425,95%CI:0. 238～0. 760,P=0. 004)、受伤至入院时间(OR=0. 576,95%CI:0. 345～0. 962,P=0. 035)以及入院GCS评分(OR=0. 768,95%CI:0. 713～0. 827,P <0. 001)为女性TBI患者出院时GCS评分改善的影响因素。结论预防老年女性受伤及尽快将伤者送医院就诊,可能改善女性TBI患者的治疗效果和预后。
Objective To provide evidence for improving the diagnosis and treatment of female traumatic brain injury( TBI) patients by studying the clinic factors of female TBI patients. Methods The clinical data of 2 368 TBI patients admitted to Department of Neurosurgery,Tianjin Medical University General Hospital from January 2011 to December 2016 were analyzed retrospectively. The clinical features of female patients and the influencing factors of Glasgow Coma Scale( GCS) when they were discharged from hospital were studied. Results The number of female TBI patients was 1/3 of male TBI patients. There were less open-injury and multi-injury patients in female than male TBI patients,but clear increase of the percent of old female TBI patients( ≥ 65 years). The primary cause of female TBI patients was traffic accident,while falling was the leading cause of ≥75 years old female TBI patients. There were more female TBI patients upon admission to hospital within 6 hours of injury and less unconscious compared to male patients; but there was no significant difference in the fatality rate between female and male patients( P > 0. 05). Univariate analysis showed that age < 65 years,time upon injury to admission≤6 hours,and lower GCS at admission may be the protective factors for GCS improvement of hospitalized women upon discharge( all P <0. 05). Multivariate analysis showed that age( OR = 0. 425,95% CI: 0. 238-0. 760,P = 0. 004),time from injury to admission( OR = 0. 576,95% CI: 0. 345-0. 962,P = 0. 035),and GCS on admission( OR = 0. 768,95% CI: 0. 713-0. 827,P < 0. 001) influence GCS improvement of TBI women discharged from hospital. Conclusions Injury prevention and reducing the time from injury to admission can improve the therapeutic effectiveness and prognosis of female TBI patients.
Objective To provide evidence for improving the diagnosis and treatment of female traumatic brain injury( TBI) patients by studying the clinic factors of female TBI patients. Methods The clinical data of 2 368 TBI patients admitted to Department of Neurosurgery,Tianjin Medical University General Hospital from January 2011 to December 2016 were analyzed retrospectively. The clinical features of female patients and the influencing factors of Glasgow Coma Scale( GCS) when they were discharged from hospital were studied. Results The number of female TBI patients was 1/3 of male TBI patients. There were less open-injury and multi-injury patients in female than male TBI patients,but clear increase of the percent of old female TBI patients( ≥ 65 years). The primary cause of female TBI patients was traffic accident,while falling was the leading cause of ≥75 years old female TBI patients. There were more female TBI patients upon admission to hospital within 6 hours of injury and less unconscious compared to male patients; but there was no significant difference in the fatality rate between female and male patients( P > 0. 05). Univariate analysis showed that age < 65 years,time upon injury to admission≤6 hours,and lower GCS at admission may be the protective factors for GCS improvement of hospitalized women upon discharge( all P <0. 05). Multivariate analysis showed that age( OR = 0. 425,95% CI: 0. 238-0. 760,P = 0. 004),time from injury to admission( OR = 0. 576,95% CI: 0. 345-0. 962,P = 0. 035),and GCS on admission( OR = 0. 768,95% CI: 0. 713-0. 827,P < 0. 001) influence GCS improvement of TBI women discharged from hospital. Conclusions Injury prevention and reducing the time from injury to admission can improve the therapeutic effectiveness and prognosis of female TBI patients.
引文
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[11]Patel HC,Bouamra O,Woodford M,et al. Clinical article:mortality associated with severe head injury in the elderly[J]. Acta Neurochir(Wien),2010,152:1353.
[12]Wong GK,Graham CA,Ng E,et al. Neurological outcomes of neurosurgical operations for multiple trauma elderly patients in Hong Kong[J]. J Emerg Trauma Shock,2011,4:346.
[13]Kehoe A,Smith JE,Bouamra O,et al. Older patients with traumatic brain injury present with a higher GCS score than younger patients for a given severity of injury[J]. Emerg Med J,2016,33:381.
[14]Albrecht JS,Mccunn M,Stein DM,et al. Sex differences in mortality following isolated traumatic brain injury among older adults[J]. J Trauma Acute Care Surg,2016,81:486.
[15]Kesmarky K,Delhumeau C,Zenobi M,et al. Comparison of two predictive models for Short-Term mortality in patients after severe traumatic brain injury[J]. J Neurotrauma,2017,34:2235.
[16]Teasdale G,Maas A,Lecky F,et al. The Glasgow coma scale at 40years:standing the test of time[J]. Lancet Neurol,2014,13:844.
[17]Lawrence T,Helmy A,Bouamra O,et al. Traumatic brain injury in England and Wales:prospective audit of epidemiology,complications and standardised mortality[J]. BMJ Open,2016,6:012197.
[2]Koskinen S,Alaranta H. Traumatic brain injury in Finland 1991—2005:A nationwide register study of hospitalized and fatal TBI[J]. Brain Injury,2008,22:205.
[3]Munivenkatappa A,Agrawal A,Shukla DP,et al. Traumatic brain injury:Does gender influence outcomes?[J]. Int J Crit Illn Inj Sci,2016,6:70.
[4]Nguyen R,Fiest KM,Mcchesney J,et al. The international incidence of traumatic brain injury:a systematic review and MetaAnalysis[J]. Can J Neurolog Sci,2016,43:774.
[5]Air M,Menon DK,Adelson PD,et al. Traumatic brain injury:integrated approaches to improve prevention,clinical care,and research[J]. Lancet Neurol,2017,16:987.
[6]王鹏,刘津贤,高闯,等. 2368例创伤性脑损伤患者临床特点分析[J].中华创伤杂志,2018,34:906.
[7]Fu TS,Jing RW,Fu WW,et al. Epidemiological trends of traumatic brain injury identified in the emergency department in a PubliclyInsured population,2002—2010[J]. PLo S One,2016,11:0145469.
[8]Peeters W,Van Den Brande R,Polinder S,et al. Epidemiology of traumatic brain injury in Europe[J]. Acta Neurochir(Wien),2015,157:1683.
[9]Stocchetti N,Paterno R,Citerio G,et al. Traumatic brain injury in an aging population[J]. J Neurotrauma,2012,29:1119.
[10]Song SY,Lee SK,Eom KS,et al. Analysis of mortality and epidemiology in 2617 cases of traumatic brain injury:Korean Neuro-Trauma data bank system 2010—2014[J]. J Korean Neurosurg Soc,2016,59:485.
[11]Patel HC,Bouamra O,Woodford M,et al. Clinical article:mortality associated with severe head injury in the elderly[J]. Acta Neurochir(Wien),2010,152:1353.
[12]Wong GK,Graham CA,Ng E,et al. Neurological outcomes of neurosurgical operations for multiple trauma elderly patients in Hong Kong[J]. J Emerg Trauma Shock,2011,4:346.
[13]Kehoe A,Smith JE,Bouamra O,et al. Older patients with traumatic brain injury present with a higher GCS score than younger patients for a given severity of injury[J]. Emerg Med J,2016,33:381.
[14]Albrecht JS,Mccunn M,Stein DM,et al. Sex differences in mortality following isolated traumatic brain injury among older adults[J]. J Trauma Acute Care Surg,2016,81:486.
[15]Kesmarky K,Delhumeau C,Zenobi M,et al. Comparison of two predictive models for Short-Term mortality in patients after severe traumatic brain injury[J]. J Neurotrauma,2017,34:2235.
[16]Teasdale G,Maas A,Lecky F,et al. The Glasgow coma scale at 40years:standing the test of time[J]. Lancet Neurol,2014,13:844.
[17]Lawrence T,Helmy A,Bouamra O,et al. Traumatic brain injury in England and Wales:prospective audit of epidemiology,complications and standardised mortality[J]. BMJ Open,2016,6:012197.