摘要：

目的: 探讨多学科诊疗模式下重型颅脑创伤合并严重多发伤患者预后相关影响因素，并总结治疗经验。方法: 纳入2016年1月至2021年6月贵州医科大学附属医院经多学科诊疗模式救治的144例重型颅脑创伤合并严重多发伤患者，出院时采用Glasgow预后分级（GOS）评价临床预后，单因素和多因素Logistic回归分析筛查重型颅脑创伤合并严重多发伤患者预后影响因素。结果: 共144例患者根据出院时GOS评分分为预后良好组（101例）和预后不良组（43例），预后不良组高血压（P=0.003）、糖尿病（P=0.004）、吸烟史（P=0.000）、饮酒史（P=0.000），入院时创伤性休克（P=0.009）和脑疝形成（P=0.000），合并胸部损伤（P=0.046）、腹部损伤（P=0.000）和脊柱损伤（P=0.009），治疗期间并发肺部感染（P=0.031）和多器官功能障碍综合征（MODS，P=0.004），呼吸机辅助通气（P=0.005），气管切开（P=0.005）比例高于预后良好组，而入院时Glasgow昏迷量表（GCS）评分（P=0.000）和脑挫裂伤比例（P=0.013）低于预后良好组。Logistic回归分析结果显示，糖尿病（OR=4.119，95% CI：2.632~5.832；P=0.042）、合并腹部损伤（OR=1.183，95% CI：1.000~1.269；P=0.006）、入院时GCS评分低（OR=4.949，95% CI：1.609~15.218；P=0.005）、治疗期间并发MODS（OR=4.642，95% CI：4.068~5.216；P=0.008）是重型颅脑创伤合并严重多发伤患者预后不良的危险因素，气管切开是预后良好的保护因素（OR=0.223，95% CI：0.062~0.384；P=0.007）。结论: 重型颅脑创伤合并严重多发伤病情复杂且救治难度大，糖尿病、合并腹部损伤、入院时GCS评分低、治疗期间并发MODS是多学科诊疗模式下重型颅脑创伤合并严重多发伤患者预后不良的危险因素。

关键词: 脑损伤, 创伤性, 多学科诊疗模式（非MeSH词）, 预后, Logistic模型, 贵州

Abstract:

Objective: To explore and analyze the influencing factors of multi - disciplinary team (MDT) model in treatment of severe traumatic brain injury (sTBI) with severe multiple injuries, and to summarize the diagnosis and treatment experience. Methods: Total 144 patients of sTBI with severe multiple injuries treated in a MDT model at The Affiliated Hospital of Guizhou Medical University from January 2016 to June 2021 were included. Glasgow Outcome Scale (GOS) was used to assess prognosis at discharge, univariate and multivariate stepwise Logistic regression analyses were used to screen for influencing factors postoperative prognosis. Results: A total of 144 patients were divided into good prognosis group (n = 101) and poor prognosis group (n = 43) according to the GOS score at discharge. The poor prognosis group included hypertension (P= 0.003), diabetes (P= 0.004), smoking (P= 0.000), drinking (P= 0.000), traumatic shock (P= 0.009) and brain hernia formation (P= 0.000), combined chest injury (P= 0.046), abdominal injury (P= 0.000) and spinal injury (P= 0.009), the proportion of concurrent pulmonary infections (P= 0.031), multiple organ dysfunction syndrome (MODS, P= 0.004), ventilator - assisted ventilation (P= 0.005), and tracheostomy (P= 0.005) during treatment were higher than those in good prognosis group, while the proportion of Glasgow Coma Scale (GCS) score (P= 0.000) and brain contusion and laceration (P = 0.013) at admission were lower than those in good prognosis group. Logistic regression analysis showed diabetes (OR= 4.119, 95%CI: 2.632-5.832; P= 0.042), abdominal injury (OR= 1.183, 95%CI: 1.000-1.269; P= 0.006), low GCS score at admission (OR= 4.949, 95%CI: 1.609-15.218; P= 0.005), and MODS during treatment (OR= 4.642, 95%CI: 4.068-5.216; P= 0.008) were risk factors for poor prognosis of patients of sTBI with severe multiple injuries, while tracheotomy was a protective factor for good prognosis (OR= 0.223, 95%CI: 0.062-0.384; P= 0.007). Conclusions: sTBI with severe multiple injuries is complicated and difficult to treat. Diabetes, combined with abdominal injury, low GCS score at admission, and MODS during treatment are risk factors for poor prognosis of patients of sTBI with severe multiple injuries under MDT.

Key words: Brain injuries, traumatic, Multi - disciplinary team (not in MeSH), Prognosis, Logistic models, Guizhou