Retrospective Analysis Of Prognostic Relevant Factors With Traumatic Brain Injury Patients

Objective: To explore relevant factors of prognostic in traumatic brain injury(TBI),summarize the experience of treatment.In order to optimize the perioperative management, reduce the mortality and morbidity. Methods: Retrospective analysis of clinical data of the patients with TBI undergone surgical operations in the First Affiliated Hospital of Guangxi Medical University during January 2013 to December 2014.Records their name, gender, age, cause of injury and type, consciousness and GCS, vital sign, encephalocele, pupil, CT, history of diabetes, hypertension, cardiopathy and so on;Preoperative blood glucose, hemoglobin, the count of WBC; use of vascular active drugs, intraoperative blood pressure and heart rate flucctuations, cardiovascular events; postoperative prognosis. Be grouped according to the GOS when patients discharged from hospital, one is favorable prognosis group(GOS 4~5),the other is poor prognosis group(GOS 1~3). Using univariate analysis to select the relevant factors influencing the prognosis of postoperative,then use Logistic regression analye the dangerous factors of the prognosis of patients with traumatic brain injuries. Results: 1.From 2013 to 2014,a total of 156 patients with TBI undergone surgical operations, eliminate 21 cases(18 cases is children under 10 years old,2 cases give up treatment and 1 case was transferred to another hospitai,both of them lost to follow-up),remain 135 cases.Among them,96 patients(71.11%) with favorable prognosis, and 39 patients in poor prognosis group(28.89%), including 8 patients(5.93%) severe disability,13 patients plant survival(9.63%), and 18 patients dead(13.33%). 2. Among the 135 case,the total mortality was 13.33%, the causes of death are encephalocele, central failure and multiple organ dysfunction syndrome(MODS).3. All of the 135 patients has11 cases(0.74%) requires a second surgery, the mainly reasons are postoperative intracranial hematoma, cerebral edema and hydrocephalus. 4. The prognostic relevant factors with TBI patients are CT classification, consciousness, pupil conditions, GCS, preoperative the WBC count and GLU, cerebral hernia, hypotension(SBP<90 mmHg) and tachycardia(>100 bpm).5. The independent risk factors of postoperative outcomes for patients with TBI are CT shows that cisterna ambiens compression or disappeared or disturbance of consciousness and preoperative high GLU,and the most is CT shows that cisterna ambiens compression or disappeared,when it appears the risk of poor prognosis increase 4.477 times. Conclusion: 1. The factors related to the prognosis of TBI patients are Cerebral hernia, CT classification, consciousness, pupil conditions, GCS, preoperative WBC count and GLU, hypotension(SBP<90 mmHg) and tachycardia(>100 bpm).2. The independent risk factors of postoperative prognosis with TBI are CT shows that cisterna ambiens compression or disappeared or disturbance of consciousness and preoperative high GLU.