Risk Factors Related to Dysautonomia After Severe Traumatic Brain Injury
Risk Factors Related to Dysautonomia After Severe Traumatic Brain Injury
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DOI：
10.1097/ta.0b013e31820ebee1
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发表时间：
2011-09-01
影响因子：
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通讯作者：
Lu, Yi-Cheng
中科院分区：
文献类型：
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作者：
Lv, Li-Quan;Hou, Li-Jun;Lu, Yi-Cheng
背景：严重创伤性脑损伤（TBI）后的自主神经功能障碍是一种影响幸存者亚群的临床综合征，其特征是自主神经失调和肌肉过度活跃。本研究的目的是确定重症监护病房中严重 TBI 后自主神经功能障碍的发生率，并分析发生自主神经功能障碍的危险因素。方法：对一家大型创伤医院在 2 年内收治的 101 名严重 TBI 患者进行连续系列前瞻性观察，以确定年龄、性别、损伤方式、高血压病史、入院收缩压、骨折、肺损伤、入院格拉斯哥昏迷量表 (GCS) 评分、损伤严重程度的影响评分、紧急开颅手术、镇静或镇痛、弥漫性轴突损伤 (DAI)、磁共振成像 (MRI) 量表和脑积水对自主神经功能障碍发展的影响。采用logistic回归分析评估自主神经功能障碍的危险因素。结果：101例患者中有79例符合纳入标准，其中16例（20.3%）患者出现自主神经功能障碍。单变量分析显示自主神经功能障碍的发生与患者年龄、入院 GCS 评分、DAI、MRI 量表和脑积水之间存在显着相关性。性别、损伤方式、高血压病史、入院收缩压、骨折、肺损伤、损伤严重程度评分、镇静或镇痛以及紧急开颅手术不影响自主神经功能障碍的发生。多变量逻辑回归显示，患者年龄和 DAI 是自主神经功能障碍的两个独立预测因素。自主神经功能障碍与入院 GCS 评分、MRI 量表或脑积水之间没有独立关联。结论：自主神经功能障碍常见于严重 TBI 患者。年龄较小和 DAI 可能是促进自主神经功能障碍发展的危险因素。
Background: Dysautonomia after severe traumatic brain injury (TBI) is a clinical syndrome affecting a subgroup of survivors and is characterized by episodes of autonomic dysregulation and muscle overactivity. The purpose of this study was to determine the incidence of dysautonomia after severe TBI in an intensive care unit setting and analyze the risk factors for developing dysautonomia.Methods: A consecutive series of 101 patients with severe TBI admitted in a major trauma hospital during a 2-year period were prospectively observed to determine the effects of age, sex, mode of injury, hypertension history, admission systolic blood pressure, fracture, lung injury, admission Glasgow Coma Scale (GCS) score, injury severity score, emergency craniotomy, sedation or analgesia, diffuse axonal injury (DAI), magnetic resonance imaging (MRI) scales, and hydrocephalus on the development of dysautonomia. Risk factors for dysautonomia were evaluated by using logistic regression analysis.Results: Seventy-nine of the 101 patients met inclusion criteria, and dysautonomia was observed in 16 (20.3%) of these patients. Univariate analysis revealed significant correlations between the occurrence of dysautonomia and patient age, admission GCS score, DAI, MRI scales, and hydrocephalus. Sex, mode of injury, hypertension history, admission systolic blood pressure, fracture, lung injury, injury severity score, sedation or analgesia, and emergency craniotomy did not influence the development of dysautonomia. Multivariate logistic regression revealed that patient age and DAI were two independent predictors of dysautonomia. There was no independent association between dysautonomia and admission GCS score, MRI scales, or hydrocephalus.Conclusions: Dysautonomia frequently occurs in patients with severe TBI. A younger age and DAI could be risk factors for facilitating the development of dysautonomia.