A Multivariate Study Of Factors Of Influence In Palinesthesia Of Comatose Patients After Brain Injury

BackgroundTraumatic brain injury is one of the Department of Neurosurgery critically ill, poor prognosis, disability rate, high death rate, cause serious harm to human health and life. The incidence of our brain injury rate was 100-200/10 million,18%-20% for severe traumatic brain injury,30%-50% finally died, so each year caused economic losses amounting to tens of billions. In patients with severe craniocerebral injury complicated with coma usually, prediction and assessment of coma patients can recovery of brain injury, has important significance on the formulation of clinical treatment in patients with severe traumatic brain injury. At present, the prognosis of head injury coma research covers the following aspects: examination of the nervous system such as pupil change and GCS score, imaging examinations such as brain CT, MRI, electrophysiological examinations such as EEG and evoked potentials, and the physiological and biochemical blood glucose, blood sodium, cerebrospinal fluid SB100 change. However due to the large regional differences in the level of medical and medical equipment, in the medical equipment underdeveloped areas, the evaluation methods was limited especially in primary hospital.ObjectivesTo investigate the prognostic factors of craniocerebral injury and coma, coma recovery rate prediction model is established after craniocerebral injury, to assist clinicians to clinical decision making.MethodsA retrospective analysis of patients with coma from February 2009 to February 2014 in our hospital department of Neurosurgery treated 380 cases of craniocerebral injury, prognosis is whether recovery. Collect 19 patients may influence factors include:gender, age, pupil size, pupillary light responses, admission GCS score, abnormal breathing, blood pressure, heart rate, combined injury, midline shift, intracranial hematoma volume, ring pool and brainstem morphological changes, brainstem auditory evoked potential (BAEP) changes, whether there is a digestive tract bleeding, blood glucose, whether with hypernatremia, whether complicated with intracranial infection, pulmonary infection, whether patients with hydrocephalus. Analysis using SPSS 19 statistical software, the influencing factors were analyzed by univariate analysis, multivariate analysis using Logistic regression analysis, to determine the factors affecting the patients recovery rate, and established the regression equation, α=0.05 level test.Results1. In this study 380 patients were enrolled, in the follow-up period,192 cases of recovery (50.5%),188 cases (49.5%) did not wake up. Age, gender, abnormal heart rate, volume of intracranial hematoma and 4 patients with recovery rate independent (P> 0.05); abnormal breathing, low blood pressure, whether associated injuries, pupillary light reflex, or mydriasis, midline shift degree, GCS score, the degree of change in brain around the pool, brainstem auditory evoked potential abnormalities, hypernatremia, digestive tract hemorrhage, pulmonary infection, intracranial infection, hydrocephalus, blood glucose of 15 patients with recovery rate correlation (P< 0.05). On the 15 influential factors in univariate analysis were analyzed by Logistic regression analysis, abnormal breathing, ring pool and brainstem classification, morphological changes of brainstem auditory evoked potential abnormalities, GCS group, hydrocephalus, intracranial infection and 6 with craniocerebral injury and coma significant correlation between patients’ recovery rate (P<0.05).2 Regression equation:Logistic(P)=19.135+2.872Xi+2.341X2-25.516X3.1-23.021X3.2-20.844X3.3-19.554X3.4+ 0.996X3.5+3.612X4+2.487X5+2.521X6。The general regression model established in this study of the judgment on the rate was 92.6%, the coefficient of determination R2=0.850 Nagelkerke model.Conclusions1. GCS score, respiratory abnormalities, abnormal brainstem auditory, ring pool and brainstem form of intracranial infection, hydrocephalus,6 factors are significant factors that influenced the prognosis of patients with craniocerebral injury.2. The regression model developed in this study can provide effective and easy way to predict the clinical work of craniocerebral injury and coma patients can wake up, for the clinical treatment of such patients. To provide a reliable basis for the formulation of therapy, is conducive to the rational allocation of health resources...