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《Chinese Journal of Critical Care Medicine》 2019-06
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Research of clinical features and prognostic factors in patients with severe traumatic brain injury with good early prognosis

Feng Ai-ping;Jiang Tao;Liu Lun-bo;Huang Qi-jun;Du Chen;Department of Neurosurgery,the Second People's Hospital of Deyang City;  
Objective To evaluate the clinical features of the patients with severe traumatic brain injury(TBI)with good early prognosis and the factors that affect the early prognosis of patients.The time characteristics of early neurological recovery in patients were analyzed.Methods Clinical data of 172 patients who recovered well and the Glasgow outcome scale(GOS)score was 4 points(moderately disabled group,n =90)or 5 points(good recovery group,n = 82)after 6 months of treatment in our neurosurgical intensive care unit(ICU)between January 2014 and December 2018 were included.The clinical indicators of patients with moderate disability and those with good recovery were compared.Twenty-four patients with severe TBI who were not included in the study but discontinued life-sustaining treatrment at the same time(suspended life-sustaining treatment group,n=24)were included.The clinical data between the patients in the life-sustaining treatment group and the patients with good prognosis(GCS score 4~5,n=172)were compared.The effect of discontinuation of lifesustaining treatment on clinical indicators of patients were evaluated.The time distribution characteristics of early neurological recovery in patients were analyzed.Patients were divided into 0~7 days group(n=114),8~14 days group(n=22),15~30 days group(n=20)and 30~180 days(n=16)group according to the time of early neurological recovery.The clinical data of each group of patients were compared.The factors that influenced the timing of early neurological recovery in patients were evaluated.Pearson correlation analysis was used to evaluate the correlation between the 6-month GOS score and the GOS scores of patients discharged,treated for 1 month,and treated for 3 months.Results The average age of patients were(28.8 ±11.3)years old.The main cause of injury was car injury(58.1%,100/172).Compared with the moderate disabled group,the GCS score of the patients in the good recovery group was significantly increased(t=2.480,P=0.014),and the incidence of pupil divergence was significantly lower at admission(χ~2=6.073,P=0.014),ICU hospitalization time(t=3.563,P0.001)and total hospital stay(t =4.989,P0.001)were significantly reduced.Compared with patients with severe TBI with a good prognosis(n=172),the GCS score(t=1.386,P0.001)was significantly lower in patients with discontinuation of life-sustaining therapy(n=24),and the incidence of bilateral pupillary non-response(χ~2 =8.131,P =0.004)was significantly improved,and the proportion of patients admitted to the Marshall CT grade VI(χ~2=9.102,P=0.003)was significantly improved.Most(66.3%,114/172)patients were able to complete the command movement within 1 week after injury,with the highest recovery rate on 1 day(26.7%,46/172).The GOS score at 6 months of onset was significantly correlated with the GOS score at 1 month(r=0.336,P0.001)and the GOS score at 3 months(r=0.562,P0.001).Conclusion In the final 2 weeks of treatment in patients with severe TBI,20.9% of patients are able to complete the mandatory action[6 points for motor response Glasgow coma scale(mGCS)].Although these patients experienced long-term intracranial pressure(ICP)monitoring and neuromuscular blockade,they are still likely to have a good prognosis.Do not prematurely stop life-sustaining treatment in patients with severe TBI.
【CateGory Index】: R651.15
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【Citations】
Chinese Journal Full-text Database 1 Hits
1 Luo Caikui;Meng Liang;Wang Yuefei;Yu Xiaoxiang;Department of Neurosurgery,Tongren Hospital of Wuhan University(Wuhan Third Hospital);;The effect of blood glucose levels on the prognosis of acute severe traumatic brain injury patients[J];中华内分泌外科杂志;2018-04
【Co-citations】
Chinese Journal Full-text Database 1 Hits
1 Feng Ai-ping;Jiang Tao;Liu Lun-bo;Huang Qi-jun;Du Chen;Department of Neurosurgery,the Second People's Hospital of Deyang City;;Research of clinical features and prognostic factors in patients with severe traumatic brain injury with good early prognosis[J];中国急救医学;2019-06
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