入院贫血对创伤性脑损伤患儿预后的影响

Effect of admission anemia on the prognosis in pediatric patients with moderate to severe traumatic brain injury

摘要:

目的：探讨入院贫血对中重型创伤性脑损伤（traumatic brain injury，TBI）患儿预后的影响。方法：回顾性分析2012年5月至2014年10月收入重庆医科大学附属儿童医院重症医学科治疗的中重型TBI患儿[入院格拉斯哥昏迷评分（Glasgow coma scale，GCS）3~13分]的临床资料，根据患儿入院时血红蛋白水平将患儿分为入院非贫血组（Hb≥100 g/L）和入院贫血组（Hb<100 g/L），采用非参数检验方法及卡方检验进行组间比较，并采用多变量logistic分析患儿死亡的独立危险因素。结果：109例患儿纳入研究，其中17例患儿院内死亡，52例患儿入院时存在贫血。与入院非贫血组患儿相比，入院贫血组患儿年龄更加幼小，入院GCS、儿童创伤评分（pediatric trauma score，PTS）评分更低，而死亡率更高，住院时间更长（均P<0.05）。经单因素分析显示，有入院贫血，入院高血糖、GCS<8、PTS<8、瞳孔反射异常和合并其他脏器损伤等因素的中重型TBI患儿病死率高（均P<0.05）。多因素logistic回归分析发现入院贫血（AOR=9.383，95%CI=1.086~81.094，P=0.042）、入院瞳孔反射异常（AOR=23.121，95%CI=3.680~145.270，P=0.001）和入院高血糖（AOR=15.181，95%CI=2.019~114.160，P=0.008）均是中重型TBI患儿死亡的独立危险因素。结论：入院贫血是中重度TBI患儿死亡的独立危险因素，而且会延长此类患儿的住院时间。

Abstract:

Objective：To explore the effect of admission anemia on the prognosis in children with moderate to severe traumatic brain injury（TBI）. Methods：This retrospective cohort study was conducted in Department of Critical Care Medicine，Children’s Hospital of Chongqing Medical University between May 2012 and October 2014 including patients with moderate to severe traumatic brain injury[Glasgow coma scale（GCS） 3 to 13]. The patients were divided into non-anemia group（Hb≥100 g/L） and anemia group（Hb<100 g/L） according to admission hemoglobin level. Non parametric test and chi square test was used to explore the differences between the groups. Multivariate logistic regression was used to identify risk factors related to mortality. Results：Totally 109 patients were enrolled and 17 patients among them died in hospital. The admission hemoglobin of 52 patients was less than 100 g/L. Compared with those of patients without admission anemia，the ages were younger，GCS and PTS were lower，and the length of hospital stay was longer in pa－tients with admission anemia（P<0.05）. Univariate analysis found that admission anemia，hyperglycemia，GCS<8，pediatric trauma score（PTS）<8，abnormal pupil reflex ratio and polytrauma significantly influenced mortality（all P<0.05）. Multivariate logistic regression analysis showed that admission anemia（AOR=9.383，95%CI=1.086 to 81.094，P=0.042），abnormal pupil reflex（AOR=23.121，95%CI=3.680 to 145.270，P=0.001） and admission hyperglycemia（AOR=15.181，95%CI=2.019 to 114.160，P=0.008） were independent risk factors for death in children with moderate or severe TBI. Conclusion：The admission anemia is an independent risk factor for the mortality of pediatric patients with moderate to severe TBI. And admission anemia is associated with prolonged hospital stay.