Jones P A, Andrews P J, Midgley S, Anderson S I, Piper I R, Tocher J L, Housley A M, Corrie J A, Slattery J, Dearden N M
Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Scotland.
J Neurosurg Anesthesiol. 1994 Jan;6(1):4-14.
Primary traumatic brain damage may be compounded by secondary pathophysiological insults that can occur soon after trauma, during transfer to hospital or subsequent treatment of the head-injured patient. The aim of this prospective study was to quantify the burden of a wide range of secondary insults occurring after head injury and to relate these to 12-month outcome. In 124 adult head-injured patients studied during intensive care using a computerized data collection system, < or = 14 clinically indicated physiological variables were measured minute-by-minute. Verified values falling outside threshold limits for > or = 5 min, as defined by the Edinburgh University Secondary Insult Grading scheme, were analysed by insult grade and duration. A greater incidence of secondary insults was detected than previous studies have indicated. Insults were found in 91% of patients and occurred in all severities of head trauma, at all ages, and at every level of Injury Severity Score (ISS). The cumulative durations were much greater than previously recorded although 85% of the total time was at the least severe grade. Short duration insults were common. In 71 patients, in whom 8 insults could be assessed (intracranial pressure, arterial hypo- and hypertension, cerebral perfusion pressure, hypoxemia, pyrexia, brady- and tachycardia), outcome at 12 months was analysed using logistic regression to determine the relative influence of age, admission Glasgow Coma Sumscore, ISS, pupil response on admission, and insult duration on both mortality and morbidity. The most significant predictors of mortality in this patient set were durations of hypotensive (p = .0064), pyrexic (p = .0137), and hypoxemic (p = .0244) insults. When good versus poor outcome was considered, hypotensive insults (p = .0118) and pupil response on admission (p = .0226) were significant.
原发性创伤性脑损伤可能会因继发性病理生理损伤而加重，这些损伤可能在创伤后不久、转送至医院途中或颅脑损伤患者后续治疗期间发生。这项前瞻性研究的目的是量化颅脑损伤后发生的各种继发性损伤的负担，并将这些损伤与12个月后的预后相关联。在124例成年颅脑损伤患者的重症监护期间，使用计算机化数据收集系统每分钟测量≤14个临床指示的生理变量。根据爱丁堡大学继发性损伤分级方案，对超过或等于5分钟超出阈值范围的已验证值，按损伤等级和持续时间进行分析。与先前研究表明的情况相比，检测到继发性损伤的发生率更高。在91%的患者中发现了损伤，且在所有严重程度的颅脑创伤、所有年龄段以及损伤严重度评分（ISS）的各个水平上均有发生。累积持续时间比之前记录的要长得多，尽管总时间的85%处于最轻微的等级。短时间损伤很常见。在71例患者中，可以评估8种损伤（颅内压、动脉低血压和高血压、脑灌注压、低氧血症、发热、心动过缓和心动过速），使用逻辑回归分析12个月时的预后，以确定年龄、入院时格拉斯哥昏迷总分、ISS、入院时瞳孔反应以及损伤持续时间对死亡率和发病率的相对影响。在该患者组中，死亡率的最显著预测因素是低血压（p = .0064）、发热（p = .0137）和低氧血症（p = .0244）损伤的持续时间。当考虑预后良好与不良时，低血压损伤（p = .0118）和入院时瞳孔反应（p = .0226）具有显著性。
