头部损伤患者的弥漫性轴索损伤：124例病例的流行病学及预后研究

Diffuse axonal injury in patients with head injuries: an epidemiologic and prognosis study of 124 cases.

作者信息

Chelly Hedi, Chaari Anis, Daoud Emna, Dammak Hssan, Medhioub Fatma, Mnif Jameleddine, Hamida Chokri Ben, Bahloul Mabrouk, Bouaziz Mounir

机构信息

Service de réanimation médicale, CHU Habib Bourguiba, Sfax, Tunisia.

出版信息

J Trauma. 2011 Oct;71(4):838-46. doi: 10.1097/TA.0b013e3182127baa.

DOI:10.1097/TA.0b013e3182127baa

PMID:21460740

Abstract

BACKGROUND

Diffuse axonal injury (DAI) is usually associated to severe trauma. Recent imaging advances made its diagnosis easier. Its prognosis impact is not yet well established. The aim of this article is to describe the epidemiologic, clinical, and radiologic features of posttraumatic DAI and to study its prognosis impact on mortality and outcome according to Glasgow Outcome Scale.

METHODS

This is a retrospective study over a 4-year period (2004-2007) of 124 patients admitted for head trauma. Demographic, clinical, biological, and radiologic findings were recorded at admission and during intensive care unit stay.

RESULTS

Mean age (±standard deviation) was 28 years±15.8 years. Cranial computed tomography scan was sufficient enough to diagnose DAI in 31 patients. Magnetic resonance imaging was performed in 105 patients with a delay of 7.7 days±8.6 days. Most patients were classified as stage II (49.5%) or stage III (44.8%) according to Gentry's classification. In a multivariate analysis, factors associated with higher mortality were dysautonomia (p=0.018; odds ratio [OR]=4.17), hyperglycemia≥8 mmol/L (p=0.001; OR=3.84) on intensive care unit admission, and subdural hematoma (p=0.031; OR=3.99), whereas factors associated to poor outcome according to Glasgow Outcome Scale score were Glasgow Coma Scale score<8 (p=0.032, OR=3.55), secondary systemic injuries score≥3 (p=0.034, OR=2.83), hyperglycemia≥8 mmol/L (p=0.002, OR=5.55), and DAI count≥6 (p=0.035, OR=3.33). In patients with pure DAI, the absence of consciousness recovery was the unique independent factor of mortality (p<0.001, OR=116.4), whereas only transfusion need was an independent factor of poor outcome (p=0.017, OR=4.44).

CONCLUSION

Dysautonomia, hyperglycemia, and subdural hematoma are the main factors associated to higher mortality when DAIs are diagnosed, whereas a DAI count≥6 is associated to poor outcome. Magnetic resonance imaging classification did not have a prognosis value even in patients with pure DAI.

摘要

背景

弥漫性轴索损伤（DAI）通常与严重创伤相关。近期影像学的进展使其诊断更加容易。但其对预后的影响尚未完全明确。本文旨在描述创伤后DAI的流行病学、临床和放射学特征，并根据格拉斯哥预后量表研究其对死亡率和预后的影响。

方法

这是一项对124例因头部创伤入院患者进行的为期4年（2004 - 2007年）的回顾性研究。在入院时及重症监护病房住院期间记录人口统计学、临床、生物学和放射学检查结果。

结果

平均年龄（±标准差）为28岁±15.8岁。31例患者通过头颅计算机断层扫描足以诊断DAI。105例患者进行了磁共振成像检查，延迟时间为7.7天±8.6天。根据Gentry分类，大多数患者被归类为Ⅱ期（49.5%）或Ⅲ期（44.8%）。在多因素分析中，与较高死亡率相关的因素为自主神经功能障碍（p = 0.018；比值比[OR] = 4.17）、重症监护病房入院时血糖≥8 mmol/L（p = 0.001；OR = 3.84）和硬膜下血肿（p = 0.031；OR = 3.99），而根据格拉斯哥预后量表评分与不良预后相关的因素为格拉斯哥昏迷量表评分<8（p = 0.032，OR = 3.55）、继发性全身损伤评分≥3（p = 0.034，OR = 2.83）、血糖≥8 mmol/L（p = 0.002，OR = 5.55）和DAI计数≥6（p = 0.035，OR = 3.33）。在单纯DAI患者中，意识未恢复是死亡率的唯一独立因素（p < 0.001，OR = 116.4），而只有输血需求是不良预后的独立因素（p = 0.017，OR = 4.44）。