Clinical And Prognostic Analysis Of Related Factors Of Diffuse Axonal Injury

Objective: to analyze the influence of clinic manifestations and corresponding clinical observations on the prognosis in patients with diffuse axonal injury, select the indices that can affect the prognosis to improve the therapeutic level of DAI patients.Method: There are totally 162 patients who were admitted in the First Affiliated Hospital of NanChang University from January 2001 to December 2008 according to the clinical diagnostic criteria of DAI. The clinical information of each patient was analyzed retrospectively. First, the patients were divided into 3 groups according to GCS on admission.Each clinical index was analyzed by Cochran-Mantel-Haenszelχ2 test or by one way analysis of variance in Student-Newman-Keuls test. Indices that indicated the severity were selected. Secondly, the patients were divided into 3 groups according to outcomes judged by GOS. The clinical indices that were related with outcome were singled out by Cochran-Mantel-Haenszelχ2 test or by one way analysis of variance in Student-Newman-Keuls test. And last, the indices which were related with outcome were analyzed by logit regression analysis, in stepwise way.Result: 1.The indices, including unstable vital signs, glucose metabolism disorder ,electrolyte disorder, abnormal pupil size and the appearance of characteristic signs on imaging, were associated with GCS levels. Gender, age, injuring reasons , associated craniocerebral injuries and shape of ambient cistern were not correlated to GCS levels statistically. 2. The indices, including unstable vital signs, glucose metabolism disorder , electrolyte disorder, abnormal pupil size , the appearance of characteristic signs , associated craniocerebral injuries and GCS on admission were correlated with outcomes. No significant associations of gender, age, injuring reasons, shape of ambient cistern and therapeutic schemes had no significant relations with the therapeutic outcome . In associated craniocerebral injuries, associated primary brain-stem injury , associated traumatic cerebral infarction and cerebral hernia were combined with therapeutic efficacy, while associated cerebral contusion and laceration , associated intracranial hematoma and associated subarachnoid hemorrhage were not combined with therapeutic efficacy . 3.The logit regression model showed that GCS on admission, abnormal pupil size , electrolyte disorder , and unstable vital signs were the best predictors of outcome in DAI patients.Conclusion: DAI is a form of serious and high-mortality craniocerebral injury. The indices, including unstable vital signs, glucose metabolism disorder ,electrolyte disorder, abnormal pupil size and the appearance of characteristic signs on imaging, will lead to bad traumatic conditions. The indices, including unstable vital signs, glucose metabolism disorder , electrolyte disorder, abnormal pupil size , the appearance of characteristic signs , associated craniocerebral injuries and GCS on admission are the important factors influencing the prognosis in patients with diffuse axonal injury. The most important of them are GCS on admission and abnormal pupil size. To prevent the above influencing factors has great significance in decreasing mortality and disability rate and improving the prognosis of DAI patients.