| Background&Objectives:Brain injury is one of the diseases that is seriously harmful to human health and life.According to the reports, the incidence of the brain injury in developed countries was as high as150-250/10million every year. While the incidence of the brain injury in china was as high as100-200/10million every year, traumatic brain injury accounted for18%-20%, the deaths accounted for18%-20%. Brain injury economic loss was as high as billions of dollars. The major risk factors for brain injury include: traffic accidents, trauma, the falling injury, violence, cut injury, firearms injury and so on. All over the world, types of traffic accidents were still the primary reason for brain injury. The traffic accident not only leads to severe head injury, and also causes many high percentage of visceral injury. Although the brain is small and light in human body, But it is a very important and fragile organ in our body. When our heads suffer from violence and strikes, the important functions of human body cause different degrees of damage and influence. Because recovery of brain function after brain trauma is difficult, brain trauma is still a major cause leading to death or disability around the world. The treatments of patients after cerebral injury occupy an important position in the trauma and neurosurgery field.Consciousness relies on normal cerebral cortex function, while the waking state depends on the interaction between normal awakening activation system and inhibitory system. Nonspecific uplink projection system which is include of brain stem reticular formation, nonspecific thalamic nuclei, rear area under the thalamus, midbrain central gray and sensory conduction fiber maintains the cerebral cortex normal awakening. They form common tension activate drive structure, so as to maintain excited state of mesh structure system. So we think the reasons lead to coma after brain injury include that:①Primary cerebral injury damage an important functional areas (such as the brainstem and the basal ganglia, thalamus, etc);②Traumatic intracranial hemorrhage harm uplink reticular activating system, Hemorrhage into the ventricles make ventricle expansion, intracranial lead to the hypothalamus and brainstem compression, deformation and shift occurred,or traumtic brain edema influence mesh structure.To assess or predict the prognosis of patients with brain injury is very important for the institution of clinical therapy. The prognosis of brain injury is concern to the patients, family members and the clinicians, while making a clinical decision, they will be more generally to give the highly quality health resources to those who have a better prognosis after clinical treatment.In this way, we can make a good and full use of our limited health resources, so as to help more patients who really needed help. Currently, the health resources in our country are limited, and which is uneven distributed. So, the early predicted of the prognosis of comatose patients after brain injury have highly clinical value and social significance.Because assessment factors affect the prognosis of comatose patients with cerebral injury are complicated, so domestic and foreign scholars use different methods and means. we conclude the factors affect the prognosis of comatose patients include:vital signs changes, neurological examination(GCS, Pupil change), Imaging examination(CT,MRI),electrophysiology (evoked potential, EEG),biochemistry(blood sugar, hypernatremia, CSF SB100).Because medical treatment and medical treatment equipments are different at each area, evaluation means is limited especially in basic-level hospitals and less developed areas. The purpose of this study is to investigate the clinical factors of influence in palinesthesia of comatose patients after brain injury, and then established a model to predict the prognosis of comatose patients after brain injury,and provide a simple and effective way to predict the palinesthesia of comatose patients after HICH and assist the clinician to make a clinical decision.Objects&Methods:1. We retrospectively reviewed the complete clinical data of190comatose patients after brain injury who admitted in the Department of Neurosurgery, Huadu hospital, the Southern Medical University, from January2008to December2010.128patients were male and79were female; age from32to90years, mean57.42±0.99years; they all have a clear history of hypertension, from1to26years, average5.84±0.36years.2. The case selection criteria:①the patients have clear medical history;②the patients was diagnosed by brain CT or MRI when they reached hospital;③the initial Glasgow coma score (GCS) is less than8;3. The case exclusion criteria:①the patients who had serious underlying diseases such as coronary heart disease, chronic bronchitis inflammation, diabetes, renal failure and so on.②the patients who gave up Therapy.4.we collected and collated the clinical data of the190cases, including a total of20possible influence factors:gender, age, abnormal respiration, low blood pressure, abnormal heartbeat, whether had composite visceral injury, whether the pupil had dilated, whether the pupil light reflex has disappeared, the initial GCS scores, volume of traumatic intracerebral hemorrhage, degrees of the midline shift, morphology changes of mesencephalon surrounding cisterna, blood glucose, hypernatremia whether had lung infection, whether had gastrointestinal bleeding, whether had lung infection whether had intracranial infection, whether had hydrocephalus and whether the patient is awakening after the hospital treatments.5. Quantify the various factors and establish a database.6. Statistical analysis:Univariate analysis:Binary variables using fourfold table Chi-square test, multi-classification variables using two independent samples nonparametric test; Quantitative variables for cerebral variance not neat, using two independent-sample approximate t test. multi-variabes analysis using no-conditional Binary Logistic regression,and determine the influence factors of the prognosis of comatose patients after brain injury, and then establish the regression equation. The significance level is a=0.05.Results:1.96of the190cases regained consciousness after the hospitalized treatment. The palinesthesia rat of our study is50.5%.2. The univariate analysis2.1The palinesthesia rate of Male and female patients were compared by the fourfold table Chi-square test, the result showed that the difference has not statistically significant (χ2=0.358, P=0.549).2.2The palinesthesia rate of the Four age-groups comatose patients after brain injury were compared by the R×C Chi-square test, the result showed that the difference has not statistically significant (χ2=7.058, P=0.070).2.3The palinesthesia rate of the comatose patients after brain injury presented abnormal breath or not were compared by the fourfold table Chi-square test, the result showed that the difference has not statistically significant (χ2=50.626, P=0.000).2.4The palinesthesia rate of the comatose patients after brain injury presented hypotension or not were compared by the fourfold table Chi-square test, the result showed that the difference has statistically significant (χ2=14.881, P=0.000).2.5The palinesthesia rate of the comatose patients after brain injury presented abnormal heart rate or not were compared by the fourfold table Chi-square test, the result showed that the difference has not statistically significant (χ2=0.740, P=0.39).2.6The palinesthesia rate of the comatose patients after brain injury had composite visceral injury or not were compared by the fourfold table Chi-square test, the result showed that the difference has statistically significant (χ2=4.354, P=0.037).2.7The palinesthesia rate of the comatose patients after brain injury with dilated pupils on admission or not were compared by the fourfold table Chi-square test, the result showed that the difference has statistically significant (χ2=25.942, P=0.000).2.8The palinesthesia rate of the comatose patients after brain injury with normal pupillary light reflex in admission or without pupillary light reflex were compared by the fourfold table Chi-square test, the result showed that the difference has statistically significant (χ2=36.010, P=0.000).2.9The palinesthesia rate of different initial GCS scores of the comatose patients after brain injury were compared by fourfold table Chi-square test, the result showed that the difference has statistically significant (χ2=57.004, P=0.000).2.10The palinesthesia rate of three different groups of hemorrhage volume were compared by the two independent samples nonparametric test, the result showed that the difference has not statistically significant (Z=-1.107, P=0.268).2.11The palinesthesia rate of different degrees of the midline shift were compared by the two independent samples nonparametric test, the result showed that the difference has not statistically significant (Z=-3.177, P=0.001). Different degrees of the midline shift and two prognosis groups were positively correlated by Spearman correlate analysis(r=0.231, P=0.001).2.12The palinesthesia rate of different morphology changes of mesencephalon surrounding cisterna were compared by the two independent samples nonparametric test, the result showed that the difference has not statistically significant (Z=-10.581, P=0.000). Different morphology changes of mesencephalon surrounding cisterna and two prognosis groups were positive correlated by Spearman correlate analysis(r=0.770, P=0.000).2.13Differences of blood glucose between two prognosis groups were compared by two independent-sample approximate t test., the result showed that the difference has statistical significance.(t=-8.838, P=0.000).2.14The palinesthesia rate of the comatose patients after brain injury presented hypernatremia or not were compared by the fourfold table Chi-square test, the result showed that the difference has statistically significant (χ2=31.632, P=0.000).2.15The palinesthesia rate of the comatose patients after brain injury who suffered gastrointestinal bleeding or not were compared by the fourfold table Chi-square test, the result showed that the difference has no statistically significant (χ2=29.033, P=0.000).2.16The palinesthesia rate of the comatose patients after brain injury who suffered pulmonary infection or not were compared by the fourfold table Chi-square test, the result showed that the difference has statistically significant (χ2=20.838, P=0.000).2.17The palinesthesia rate of the comatose patients after brain injury who suffered intracranial infection or not were compared by the fourfold table Chi-square test, the result showed that the difference has statistically significant (χ2=6.713, P=0.010).2.18The palinesthesia rate of the comatose patients after brain injury who suffered hydrocephalus or not were compared by the fourfold table Chi-square test, the result showed that the difference has statistically significant (χ2=10.397, P=0.001).3. The Multivariate analysis3.1In the univariate analysis,14factors related to the palinesthesia of comatose patients after brain injury, which were put into the Logistic regression model (Forward:LR) to analysis. The result indicated that five influence factors associated with the palinesthesia of comatose patients brain injury (P<0.05), which included abnormal respiration, the initial GCS scores, morphology changes of mesencephalon surrounding cisterna, whether had intracranial infection, whether had hydrocephalus.All these influence factors the dangerous factors of the palinesthesia of comatose patients after brain injury.3.2The regression equation: Logistic(P)=18.531+1.783X1+1.452X2-24.484X3.1-22.903X3.2-21.156X3.3-18.461X3.4+1.004X3.5+2.398X4+2.488X5The Nagelkerke’s coefficient of determination R2of the regression model was0.850. The total correct rate of the equation while used it to predict who will palinesthesia in all1cases was92.6%.Conclusions: 1. In our study, we found that abnormal respiration, the initial GCS scores, morphology changes of mesencephalon surrounding cisterna, whether had intracranial infection, whether had hydrocephalus.All these influence factors the dangerous factors of the palinesthesia of comatose patients after brain injury.2. In our study we established a regression model, which provided a convenient ways for clinicians to assess the prognosis of comatose patients after brain injury in a earlier state after onset and to assist them making a clinical decision. |
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