神经重症昏迷患者不良预后相关因素分析

Analysis of factors associated with poor prognosis in patients with severe neurological coma

摘要:

目的：探讨神经重症昏迷患者不良预后的相关因素。方法：采用回顾性调查方法，纳入2017年1月至2018年4月在重庆医科大学附属第一医院住院治疗的昏迷患者[格拉斯哥昏迷评分（Glasgow coma score，GCS）≤8分]共117例，出院时根据格拉斯哥预后评分（Glasgow outcome score，GOS）将患者分为生存组（74例）和死亡组（43例）。由专人对入选患者病历进行回顾性分析，分析资料包括：病史资料（性别、年龄、诊断、器官功能不全个数），病情评估资料（GCS评分、急性生理与慢性健康评分APACHE Ⅱ评分），脑电图指标（发病72 h内脑电图模式、基本背景、波幅特点、通过脑电图背景及波幅特点进行Synek分级、反应性、睡眠波），72 h内生化指标（Na+、K+、Cl-、Ca2+、白蛋白、乳酸等）。结果： Logistic回归分析显示脑电图反应性OR值为4.717，95%CI=1.333~16.686；年龄OR值为1.057，95%CI=1.020~1.095；APACHE Ⅱ评分OR值为1.201，95%CI=1.082~1.334；GCS评分OR值为4.705，95%CI=1.322~16.743（均P＜0.05）。结论：脑电图反应性、年龄、APACHE Ⅱ评分、GCS评分均与神经重症昏迷患者急性期死亡风险具有相关性，临床上应密切关注该类指标变化，以便及时、客观、全面对患者进行预后判定。

Abstract:

Objective：To explore related factors of poor prognosis in patients with severe neurological coma. Methods：A total of 117 patients with coma [Glasgow coma score（GCS）≤8] were included from January 2017 to April 2018 in The First Affiliated Hospital of Chongqing Medical University with the retrospective investigation method，and were divided into the survival group（n=74） and the death group（n=43） according to the Glasgow outcome score（GOS） when discharged. Data of included patients were retrospectively analyzed by specific person and analytical data included medical history data（gender，age，diagnosis and organs with incomplete function），disease assessment data[GCS score，acute physiology and chronic health evaluation（APACHE） Ⅱ score]，EEG indicator （EEG pattern within 72 hours of onset，basic background，amplitude characteristics，Synek grading by EEG background and amplitude characteristics，reactivity and sleep wave），and biochemical indicators within 72 hours（Na+，K+，Cl-，Ca2+，albumin，lactic acid and etc.）. Results：Logistic regression analysis showed that OR value of EEG reactivity was 4.717，95%CI=1.333 to 16.686；OR value of age was 1.057，95%CI=1.020 to 1.095；OR value of APACHE Ⅱ score was 1.201，95%CI=1.082 to 1.334；OR value of GCS score was 4.705，95%CI=1.322 to 16.743；all values were P<0.05. Conclusion：EEG reactivity，age，APACHE Ⅱ score，GCS score have association with death risks in acute phase in patients with severe neurological coma. In the clinical，we should pay close attention to those indicators，so as to make timely，objective and comprehensive prognostic judgments on patients.