Marescal C, Adnet P, Bello N, Halle I, Forget A P, Boittiaux P
Service d'accueil des urgences, hôpital R-Salengro, CHRU de Lille, France.
Ann Fr Anesth Reanim. 1998;17(3):234-9. doi: 10.1016/s0750-7658(98)80005-1.
To assess incidence of secondary brain insults of systemic origin (SBISOs) such as arterial hypotension, hypoxaemia, hypercarbia, and anaemia in severely head injured children; to assess their impact on mortality and morbidity in the short- and long-term.
Prospective, open study covering a 24-month period.
Seventy-one children, under 15 years of age, admitted to a trauma centre for severe brain injury.
Analysis of SBISOs and outcome.
Twenty-five children were admitted with SBISOs. The mortality rate was 37%. After hospitalization, 84% of the children with SBISOs vs 46% without SBISOs had severe disability (Glasgow outcome score = 1, 2 and 3). After 1 year, 20 out of the 45 children still alive were contacted. One of the four with SBISOs communicated a bad recovery. Fifteen children without SBISOs presented good recovery: GOS = 4-5, paediatric overall performance category (POPC scale) = 1-2.
Hypotension was associated with significant increase in mortality (x 3.6) in children with severe head injury. The consequences were worse when anaemia was associated.
评估重度颅脑损伤儿童中系统性原因导致的继发性脑损伤（SBISO）的发生率，如动脉低血压、低氧血症、高碳酸血症和贫血；评估其对短期和长期死亡率及发病率的影响。
前瞻性开放性研究，为期24个月。
71名15岁以下因重度脑损伤入住创伤中心的儿童。
分析SBISO及预后情况。
25名儿童伴有SBISO。死亡率为37%。住院后，伴有SBISO的儿童中84%出现严重残疾（格拉斯哥预后评分=1、2和3），而无SBISO的儿童中这一比例为46%。1年后，对仍存活的45名儿童中的20名进行了随访。伴有SBISO的4名儿童中有1名恢复不佳。15名无SBISO的儿童恢复良好：格拉斯哥预后评分=4-5，儿科总体表现类别（POPC量表）=1-2。
低血压与重度颅脑损伤儿童的死亡率显著增加（3.6倍）相关。当合并贫血时，后果更严重。
