Belavić M, Jančić E, Mišković P, Brozović-Krijan A, Bakota B, Žunić J
Department of Anaesthesiology, Reanimatology and Intensive Medicine, Karlovac General Hospital, Andrije Štampara 3, 47000 Karlovac, Croatia.
Department of Neurology, Karlovac General Hospital, Andrije Štampara 3, 47000 Karlovac, Croatia.
Injury. 2015 Nov;46 Suppl 6:S31-5. doi: 10.1016/j.injury.2015.10.057. Epub 2015 Nov 24.
Traumatic brain injury (TBI) is divided into primary and secondary brain injury. Primary brain injury occurs at the time of injury and is the direct consequence of kinetic energy acting on the brain tissue. Secondary brain injury occurs several hours or days after primary brain injury and is the result of factors including shock, systemic hypotension, hypoxia, hypothermia or hyperthermia, intracranial hypertension, cerebral oedema, intracranial bleeding or inflammation. The aim of this retrospective analysis of a prospective database was to determine the prevalence of secondary stroke and stroke-related mortality, causes of secondary stroke, treatment and length of stay in the ICU and hospital. This study included patients with TBI with or without other injuries who were hospitalised in a general ICU over a five-year period. The following parameters were assessed: demographics (age, sex), scores (Glasgow Coma Score, APACHE II, SOFA), secondary stroke (prevalence, time of occurrence after primary brain injury, causes of stroke and associated mortality), length of stay in the ICU and hospital, vital parameters (state of consciousness, cardiac function, respiration, circulation, thermoregulation, diuresis) and laboratory values (leukocytes, C-reactive protein [CRP], blood glucose, blood gas analysis, urea, creatinine). Medical data were analysed for 306 patients with TBI (median age 56 years, range 18-93 years) who were treated in the general ICU. Secondary stroke occurred in 23 patients (7.5%), 10 of whom died, which gives a mortality rate of 43.4%. Three patients were excluded as the cause of the injury was missile trauma. The study data indicate that inflammation is the most important cause of secondary insults. Levels of CRP were elevated in 65% of patients with secondary brain injury; leukocytosis was present in 87% of these patients, and blood glucose was elevated in 73%. The lungs and urinary tract were the most common sites of infection. In conclusion, elevated inflammatory markers (white blood cell count and CRP) and hyperglycaemia are associated with secondary brain injury. The lack of routine use of intracranial pressure (ICP) monitoring may explain the high mortality rate and the occurrence of secondary stroke in patients with TBI.
创伤性脑损伤（TBI）分为原发性和继发性脑损伤。原发性脑损伤发生在受伤时，是动能作用于脑组织的直接后果。继发性脑损伤发生在原发性脑损伤数小时或数天后，是由休克、全身性低血压、缺氧、体温过低或过高、颅内高压、脑水肿、颅内出血或炎症等因素导致的。这项对前瞻性数据库的回顾性分析旨在确定继发性中风的患病率、与中风相关的死亡率、继发性中风的原因、重症监护病房（ICU）和医院的治疗情况及住院时间。本研究纳入了在五年期间入住综合ICU的有或无其他损伤的TBI患者。评估了以下参数：人口统计学特征（年龄、性别）、评分（格拉斯哥昏迷评分、急性生理与慢性健康状况评分系统II、序贯器官衰竭评估）、继发性中风（患病率、原发性脑损伤后发生时间、中风原因及相关死亡率）、ICU和医院的住院时间、生命体征参数（意识状态、心功能、呼吸、循环、体温调节、利尿）以及实验室值（白细胞、C反应蛋白[CRP]、血糖、血气分析、尿素、肌酐）。对在综合ICU接受治疗的306例TBI患者（中位年龄56岁，范围18 - 93岁）的医疗数据进行了分析。23例患者（7.5%）发生了继发性中风，其中10例死亡，死亡率为43.4%。3例因损伤原因是导弹伤而被排除。研究数据表明炎症是继发性损伤的最重要原因。65%的继发性脑损伤患者CRP水平升高；这些患者中87%存在白细胞增多，73%血糖升高。肺部和尿路是最常见的感染部位。总之，炎症标志物（白细胞计数和CRP）升高及高血糖与继发性脑损伤相关。缺乏常规的颅内压（ICP）监测可能解释了TBI患者的高死亡率和继发性中风的发生。
