Egea-Guerrero J J, Gordillo-Escobar E, Revuelto-Rey J, Enamorado-Enamorado J, Vilches-Arenas A, Pacheco-Sánchez M, Domínguez-Roldán J M, Murillo-Cabezas F
NeuroCritical Care Unit, Virgen del Rocío University Hospital, Seville, Spain.
Transplant Proc. 2012 Sep;44(7):2050-2. doi: 10.1016/j.transproceed.2012.07.070.
The aim of this study was to ascertain the role of clinical variables and neuromonitoring data as predictors of brain death (BD) after severe traumatic brain injury (TBI).
This prospective observational study involved severe TBI patients admitted to the intensive care unit between October 2009 and May 2011. The following variables were recorded: gender, age, reference Glasgow Coma Scale after resuscitation, pupillary reactivity, prehospital hypotension and desaturation, injury severity score, computed tomography (CT) findings, intracranial hypertension, and low brain tissue oxygenation (Pti02) levels (<16 mm Hg), as well as the final result of BD.
Among 61 patients (86.9% males) who met the inclusion criteria, the average age was 37.69 ± 16.44 years. Traffic accidents were the main cause of TBI (62.3%). The patients at risk of progressing to BD (14.8% of the entire cohort) were those with a mass lesion on CT (odds ratio [OR] 33.6; 95% confidence interval [CI]: 3.75-300.30; P = .002), altered pupillary reaction at admission (OR 25.5; 95% CI: 2.27-285.65; P = .009), as well low Pti02 levels on admission (OR 20.41; 95% CI: 3.52-118.33; P < .001) and during the first 24 hours of neuromonitoring (OR 20; 95% CI: 2.90-137.83; P < .001). Multivariate logistic regression showed that a low Pti02 level on admission was the best independent predictor for BD (OR 20.41; 95% CI: 3.53-118.33; P = .001).
Clinical variables and neuromonitoring information may identify TBI patients at risk of deterioration to BD.
本研究旨在确定临床变量和神经监测数据作为重度创伤性脑损伤（TBI）后脑死亡（BD）预测指标的作用。
这项前瞻性观察性研究纳入了2009年10月至2011年5月间入住重症监护病房的重度TBI患者。记录了以下变量：性别、年龄、复苏后格拉斯哥昏迷量表参考值、瞳孔反应、院前低血压和血氧饱和度降低、损伤严重程度评分、计算机断层扫描（CT）结果、颅内高压以及低脑组织氧分压（Pti02）水平（<16 mmHg），以及BD的最终结果。
在符合纳入标准的61例患者（86.9%为男性）中，平均年龄为37.69±16.44岁。交通事故是TBI的主要原因（62.3%）。有进展为BD风险的患者（占整个队列的14.8%）为CT显示有占位性病变者（比值比[OR] 33.6；95%置信区间[CI]：3.75 - 300.30；P = .002）、入院时瞳孔反应改变者（OR 25.5；95% CI：2.27 - 285.65；P = .）、入院时Pti02水平低者（OR 20.41；95% CI：3.52 - 118.33；P < .001）以及在神经监测的最初24小时内Pti02水平低者（OR 20；95% CI：2.90 - 137.83；P < .001）。多因素逻辑回归显示，入院时低Pti02水平是BD的最佳独立预测指标（OR 20.41；95% CI：3.53 - 118.33；P = .001）。
临床变量和神经监测信息可识别有恶化至BD风险的TBI患者。
