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弥漫性轴索损伤:流行病学、结局及相关危险因素

Diffuse Axonal Injury: Epidemiology, Outcome and Associated Risk Factors.

作者信息

Vieira Rita de Cássia Almeida, Paiva Wellingson Silva, de Oliveira Daniel Vieira, Teixeira Manoel Jacobsen, de Andrade Almir Ferreira, de Sousa Regina Márcia Cardoso

机构信息

School of Nursing, University of São Paulo (USP-SP) , São Paulo , Brazil.

Department of Neurology, School of Medicine, University of São Paulo (USP-SP) , São Paulo , Brazil.

出版信息

Front Neurol. 2016 Oct 20;7:178. doi: 10.3389/fneur.2016.00178. eCollection 2016.

Abstract

Diffuse axonal injury (DAI), a type of traumatic injury, is known for its severe consequences. However, there are few studies describing the outcomes of DAI and the risk factors associated with it. This study aimed to describe the outcome for patients with a primary diagnosis of DAI 6 months after trauma and to identify sociodemographic and clinical factors associated with mortality and dependence at this time point. Seventy-eight patients with DAI were recruited from July 2013 to February 2014 in a prospective cohort study. Patient outcome was analyzed using the Extended Glasgow Outcome Scale (GOS-E) within 6 months of the traumatic injury. The mean Injury Severity Score was 35.0 (SD = 11.9), and the mean New Injury Severity Score (NISS) was 46.2 (SD = 15.9). Mild DAI was observed in 44.9% of the patients and severe DAI in 35.9%. Six months after trauma, 30.8% of the patients had died, and 45.1% had shown full recovery according to the GOS-E. In the logistic regression model, the severity variables - DAI with hypoxia, as measured by peripheral oxygen saturation, and hypotension with NISS value - had a statistically significant association with patient mortality; on the other hand, severity of DAI and length of hospital stay were the only significant predictors for dependence. Therefore, severity of DAI emerged as a risk factor for both mortality and dependence.

摘要

弥漫性轴索损伤(DAI)是一种创伤性损伤,以其严重后果而闻名。然而,很少有研究描述DAI的预后及其相关危险因素。本研究旨在描述创伤后6个月初诊为DAI的患者的预后,并确定在这个时间点与死亡率和依赖相关的社会人口统计学和临床因素。在一项前瞻性队列研究中,于2013年7月至2014年2月招募了78例DAI患者。在创伤性损伤后6个月内使用扩展格拉斯哥预后量表(GOS-E)分析患者预后。平均损伤严重程度评分为35.0(标准差=11.9),平均新损伤严重程度评分(NISS)为46.2(标准差=15.9)。44.9%的患者观察到轻度DAI,35.9%为重度DAI。创伤后6个月,根据GOS-E,30.8%的患者死亡,45.1%的患者完全康复。在逻辑回归模型中,严重程度变量——通过外周血氧饱和度测量的伴有缺氧的DAI以及伴有NISS值的低血压——与患者死亡率有统计学显著关联;另一方面,DAI的严重程度和住院时间是依赖的唯一显著预测因素。因此,DAI的严重程度成为死亡率和依赖的危险因素。

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