日均发热次数对颅脑损伤伤情影响的临床意义

doi:10.3877/cma.j.issn.2095-9141.2021.03.003

目的

探讨颅脑损伤（TBI）患者日均发热次数与其早期伤情改变的关系。

方法

回顾性分析空军军医大学第一附属医院神经外科重症监护室自2013年10月至2019年6月收治的469例TBI患者的临床资料。根据患者出院时的GOS评分将其分为预后良好组（GOS>3分）和预后不良组（GOS≤3分）。统计患者住院期间日均发热次数、年龄、入院GCS评分、伤因等。采用单因素和多因素Logistic回归分析法分析影响伤情加重的风险因素，通过绘制受试者工作曲线（ROC）评价伤情加重危险因素的诊断效能，并进一步分析患者发热的原因。

结果

预后不良组319例，预后良好组150例。单因素分析显示，年龄、入院GCS评分、伤因及日均发热次数与TBI伤情变化的影响因素（均P<0.01）。多因素Logistic回归分析显示，年龄、入院GCS评分及日均发热次数是改变TBI患者早期伤情的独立风险因素，ROC曲线提示日均发热次数具备一定的诊断效能，进一步分析显示，肺部感染可使日均发热次数增多，是加重伤情的重要因素之一。

结论

初步推断日均发热次数是TBI患者伤情加重的危险因素之一，可作为一种无创简便的监测手段判断伤情改变。

关键词: 颅脑损伤, 发热, 二次脑损伤, 影响因素

Objective

To explore the relationship between daily fever frequency and early injury changes in patients with traumatic brain injury (TBI).

Methods

Four hundred and sixty-nine patients with TBI treated in Neurosurgery Intensive Care Unit of the First Affiliated Hospital, Air Force Military Medical University from October 2013 to June 2019 were analyzed retrospectively. According to the GOS scores at the time of discharge, the patients were divided into two groups: the good prognosis group (GOS>3) and the poor prognosis group (GOS≤3). The daily fever frequency, ages, admission GCS and injury causes during hospitalization were collected. Univariate and multivariate Logistic regression analysis were used to analyze the risk factors causing aggravating injury, and the diagnostic efficacy of aggravating risk factors was evaluated by the receiver operating characteristic curve (ROC). The causes of fever were further analyzed.

Results

Three hundred and nineteen patients had a poor early prognosis and 150 had a good early prognosis. Univariate analysis showed that age, admission GCS score, causes of injury and daily fever frequency may be the influencing factors of the aggravating injury with TBI (P<0.01). Multivariate Logistic regression analysis showed that age, admission GCS score and the daily fever frequency were independent risk factors to change the early injury of TBI patients. ROC curve showed that daily fever frequency had diagnostic efficacy. Further analysis showed that pulmonary infection could increase daily fever frequency, which was one of the most important factors aggravating injury.

Conclusion

It is concluded that the daily fever frequency is one risk factor aggravating injury and it can be used as a non-invasive and simple monitoring method to judge the injury changes.

Key words: Traumatic brain injury, Fever, Secondary brain injury, Influence factor

表1 2组颅脑损伤患者的临床资料比较

临床因素		预后不良组(n=319)	预后良好组(n=150)	χ²/t/U值	P值
年龄（±s，岁）		48.6±17.0	40.7±15.0	4.875	<0.001
性别（男/女）		271/48	127/23	0.113	0.933
入院GCS评分（±s，分）		5.5±2.3	9.4±3.5	-12.239	<0.001
致伤因素[例(%)]				17.503	<0.001
	车祸伤	139(43.5)	51(34.0)
	坠落伤	79(24.7)	22(14.6)
	其他	101(31.8)	77(51.4)
入院平均动脉压（±s，mmHg）		97.6±13.6	94.7±11.5	2.389	0.018
住院时长[M(P₂₅，P₇₅)，d]		13(7,23)	11(8,16)	2.017	0.041
日均发热次数[M(P₂₅，P₇₅)，次]		0.9(0.3,2.3)	0.4(0.1,0.8)	5.749	<0.001

表1 2组颅脑损伤患者的临床资料比较

临床因素		预后不良组(n=319)	预后良好组(n=150)	χ²/t/U值	P值
年龄（±s，岁）		48.6±17.0	40.7±15.0	4.875	<0.001
性别（男/女）		271/48	127/23	0.113	0.933
入院GCS评分（±s，分）		5.5±2.3	9.4±3.5	-12.239	<0.001
致伤因素[例(%)]				17.503	<0.001
	车祸伤	139(43.5)	51(34.0)
	坠落伤	79(24.7)	22(14.6)
	其他	101(31.8)	77(51.4)
入院平均动脉压（±s，mmHg）		97.6±13.6	94.7±11.5	2.389	0.018
住院时长[M(P₂₅，P₇₅)，d]		13(7,23)	11(8,16)	2.017	0.041
日均发热次数[M(P₂₅，P₇₅)，次]		0.9(0.3,2.3)	0.4(0.1,0.8)	5.749	<0.001

表2 影响颅脑损伤患者早期伤情加重的多因素Logistic回归分析

临床因素	OR值	95%CI	P值
年龄	1.035	1.019～1.051	<0.001
入院GCS评分	0.667	0.609～0.730	<0.001
伤因	1.017	0.991～1.034	0.836
日均发热次数	1.528	1.200～1.946	0.001

表2 影响颅脑损伤患者早期伤情加重的多因素Logistic回归分析

临床因素	OR值	95%CI	P值
年龄	1.035	1.019～1.051	<0.001
入院GCS评分	0.667	0.609～0.730	<0.001
伤因	1.017	0.991～1.034	0.836
日均发热次数	1.528	1.200～1.946	0.001

图1 独立风险因素影响颅脑损伤患者早期伤情改变的ROC曲线

表3 2组颅脑损伤患者发热可能原因分析[例（%）]

发热可能原因	预后不良组(n=289)	预后良好组(n=122)	χ²值	P值
单纯肺部感染	154(53.2)	36(29.5)	21.728	<0.001
单纯颅内感染	3(1.0)	2(1.6)		0.320
合并肺部及颅内感染	3(1.0)	0		0.285
其他原因	129(44.8)	84(68.9)	20.136	<0.001

表3 2组颅脑损伤患者发热可能原因分析[例（%）]

发热可能原因	预后不良组(n=289)	预后良好组(n=122)	χ²值	P值
单纯肺部感染	154(53.2)	36(29.5)	21.728	<0.001
单纯颅内感染	3(1.0)	2(1.6)		0.320
合并肺部及颅内感染	3(1.0)	0		0.285
其他原因	129(44.8)	84(68.9)	20.136	<0.001

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Clinical significance of daily fever frequency on traumatic brain injury

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Clinical significance of daily fever frequency on traumatic brain injury