Study On Risk Factors Of Acute Respiratory Distress Syndrome Following Isolated Severe Traumatic Brain Injury

Objective:Traumatic brain injury(TBI)is one of the most important causes of death and disability worldwide.Acute respiratory distress syndrome(ARDS)often appears after severe craniocerebral injury.The vicious circle between persistent hypoxia and secondary nerve cell injury leads to the complication of clinical treatment and aggravates the social and family burden.Although the risk factors for post-traumatic ARDS have received extensive attention.However,as simple craniocerebral injury is a common type of trauma in clinical practice,the incidence and related risk factors of ARDS are rarely studied.The purpose of this study was to explore the risk factors related to ARDS after severe head injury alone,and to establish the relevant risk prediction model,in order to provide a new treatment idea for clinical treatment of head injury.Methods:We performed a subgroup analysis of 210 consecutive patients with isolated severe TBI enrolled in a prospective observationalcohort at our trauma center between 2015 and 2019.A total of 62 TBI patients with ARDS after admission were selected as the observation group.A total of 148 hospitalized TBI patients without secondary ARDS within 4 years were selected as the control group.Collect patients General basic information(age,gender,previous smoking history,vomiting history,shock history),degree of trauma(AIS score,ISS score,GCS score),and relevant laboratory indicators(hemoglobin,platelet count,PT,INR,alkali residual)were collected.Data on related treatments(craniocerebral surgery,blood transfusion,fluid rehydration)and clinical outcomes(MODS,days of hospitalization,number of deaths).The risk factors of acute respiratory distress syndrome after severe craniocerebral injury were studied by univariate and multivariate statistical analysis.Results:Acute respiratory distress syndrome occurred in 62 of the 210 isolated severe TBI in the study,and the incidence of ARDS was about 29.52%.In the observation group,72.58% of patients appeared ARDS within 4 days of injury,and almost all cases appeared ARDS within 9 days after craniocerebral trauma.In univariate analysis,7factors(male,aspiration,GCS score,platelet transfusion,brain surgery,BE <-6 within12 hours of admission,shock)were found to have statistically significant differences between groups(P<0.05),Indicating that these factors may be related to the occurrence of ARDS after severe head injury.In the multivariate logistic regression analysis,low GCS score,male,platelet transfusion,and shock were the risk factors for the occurrence of ARDS after severe TBI.Although there was no significant difference in all-cause mortality between the two groups,the incidence of MODS,ICU monitoring time,and length of stay in the ARDS group after simple severe head injury were much higher than those in the control group,and the difference was statistically significant(P <0.05).Conclusion:The incidence of ARDS after simple severe head injury in our hospital is about29.52%.Low GCS score,male,early platelet transfusion,and shock are independent risk factors for ARDS after simple severe head injury.Attention should be paid to identifying male patients with low GCS scores after the early stage of craniocerebral injury,which is of great significance to the evaluation of the patient’s condition.Early platelet transfusion may be a changeable risk factor for ARDS after a simple severe head injury.In the early hemostatic and resuscitation of head injury,attention should be paid to identifying the risks related to blood transfusion,and joint intervention may reduce the occurrence of head injury complications.