黄元飞 赵立孝 吴燕 余长智

摘要：目的 探讨临床常用各项评分对颅脑损伤合并多发伤患者患者预后的评价，构建模型验证能力。 方法 选择78例颅脑损伤合并多发伤患者作为研究对象，完善各项评分，观察1月内预后情况，应用各项评分判定患者预后，并进行单因素和多因素Cox回归分析。 结果  本研究78例患者死亡率15.38%;GCS、APACHE-II、MHIPS和CRMAS是颅脑损伤合并多发伤患者1月内死亡的独立影响因素;GCS增加1分死亡风险降低至原来的66.50%，APACHE-II增加1分死亡风险上升至原来的121.70%，CRMAS增加1分死亡风险降低至原来的65.50%;APACHE-II对颅脑损伤合并多发伤预后具有预测效果，临界值为40.81时具有最佳特异度和敏感度。结论  颅脑损伤患者救治中迅速积极完善GCS、APACHE-II、MHIPS和CRMAS评分有助于预后判断，其中APACHE-II≥40.81对颅脑损伤合并多发伤预后具有预测效果。

关键词：颅脑损伤;多发伤;预后

【中图分类号】R651.1   【文献标识码】A   【文章编号】1673-9026（2020）06-065-02

Analysis of prognostic factors of craniocerebral injury combined with multiple injuries

YuanfeiHuang  LixiaoZhao  YanWu  ChangzhiYu

The first Division Hospital of Xinjiang Production and Construction Corps Emergency ward  Xinjiang  Aksu 843000

[Abstract] Objective To evaluate the prognosis of patients with craniocerebral injury combined with multiple injuries by various clinical scores， and to establish model verification ability. Methods a total of 78 patients with craniocerebral injury combined with multiple injuries were selected as the study subjects， and all the scores were improved to observe the prognosis of the patients within 1 month. The prognosis of the patients was determined by all the scores， and univariate and multivariate Cox regression analysis was performed. Results The mortality rate of 78 patients was 15.38%. GCS， Apach-II， MHIPS and CRMAS were independent influencing factors of death within 1 month in patients with craniocerebral injury combined with multiple injuries. The risk of death by 1 point increased by GCS reduced to the original 66.50%， the risk of death by 1 point increased by Apache-II increased to the original 121.70%， and the risk of death by 1 point increased by CRMAS reduced to the original 65.50%. Apache-ii has predictive effect on the prognosis of craniocerebral injury combined with multiple injuries， and has the best specificity and sensitivity when the critical value is 40.81. Conclusion The rapid and active improvement of GCS， Apach-II， MHIPS and CRMAS scores in the treatment of patients with craniocerebral injury contributes to the prognosis judgment， among which Apach-II ≥40.81 has predictive effect on the prognosis of patients with craniocerebral injury combined with multiple injuries.

多发伤指由同一原因导致的人体两处及两处以上躯干、脏器等严重损伤。近年来，随着我国基建和交通的飞速发展，各类高能量因素引起的严重创伤随之增加，车祸、坠落伤逐渐增多，其中颅脑损伤合并多发伤是最为严重的一种，其病情复杂、伤情变化快、危害巨大、救治困难，可引起多种并發症，给临床救治和预后转归带来考验[1]。颅脑损伤合并多发伤受到多种因素的影响，为改善预后，有效控制影响因素，本研究选择2019年1月至2020年1月期间本院收治的颅脑损伤合并多发伤患者78例的临床资料作为研究对象，回顾性分析影响因素，为颅脑损伤合并多发伤的急诊救治提供依据，现报道如下。……