摘要
目的探讨甲状腺素治疗对特重型创伤性脑损伤（TBI）患者的疗效。方法采用回顾性病例对照研究分析2010年7月1日-2014年4月30日收治的105例特重型TBI患者临床资料，其中男79例，女26例；平均年龄32．9岁。按随机数字表法将患者分为常规治疗组（A组，35例）、常规治疗＋甲状腺素治疗组（B组，35例）和甲状腺素水平低时甲状腺素治疗组（C组，35例）。对比分析各组入院后低甲状腺素水平、低血压发生率、血管活性药物用量、肝肾功能损伤、格拉斯哥预后评分（GCS）、急性生理与慢性健康评估Ⅱ（APACHEⅡ）评分和病死率等。结果入院后20d内，B组低甲状腺素水平和低血压发生率（23％、77％）显著低于其他两组（A组40％、100％；C组37％、100％）（P〈0．05），C组与A组差异无统计学意义（P〉0．05）。多巴胺和去甲肾上腺素剂量B组显著低于其他两组（P〈0．05），开压药联合用药率B组显著低于其他两组（P〈0．05），而A组与C组比较差异无统计学意义（P〉0．05）。B组肝肾功能异常率（29％、31％）显著低于其他两组（A组49％、51％；C组43％、51％）（P〈0．05），c组与A组差异无统计学意义（P〉0．05）。入院后30dB组GCS[（4．8±1．9）分]显著高于A组[（3．3±0．2）分]和人院时[（3．6±1．1）分]（P〈0．05）；A组APACHEⅡ评分显著高于其他两组和入院时（P均〈0．05）；病死率A组（69％）显著高于B组（31％）和c组（29％）（P〈0．05）。结论甲状腺素治疗可以降低特重型TBI后低血压发生率、肝肾损伤率，且预防优于补充治疗，还可降低病死率。
Objective To investigate the effects of thyroid hormone on extremely severe traumatic brain injury （TBI）. Methods A retrospective case-control study was conducted to analyze the treatment of 105 patients with extremely severe TBI admitted from July 2010 to April 2014. There were 79 males and 26 females, with an average age of 32. 9 years. The patients were divided into conventional treatment group （Group A, 35 cases）, conventional treatment ＋ thyroxine treatment group （Group B, 35 cases ） and thyroxine treatment group after the condition that thyroxine level was low （Group C, 35 cases） according to the random number table method. The incidence of low T3 and T4, incidence of hypotension, the dosage of vasoactive drugs, function evaluation of liver and kidney damage, Glasgow outcome scale （ GOS ） , and acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ ） within 20 days after admission, and mortality rate within 30 days after admission were compared and analyzed. Results Within 20 days after admission, the rates of low thyroxine levels and hypotension of the Group B （22.9%, 77.1% ） were significantly lower than those in the other two groups （Group A：40% , 100% ;Group C：37%, 100% ） （all P 〈0.05）. The doses of dopamine and norepinephrine in Group B was significantly lower than the other two groups and the combination rate of vasopressors in Group B was significantly lower than the other two groups （ P 〈 0. 05 ） , while there was no significant difference between Group A and Group C （ P 〉 0.05） . The corresponding data in Group A and Group C had no statistically significant difference （ P 〉 0.05 ）. The liver and renal dysfunction rates of Group B （29%, 31% ） were significantly lower than those of the other two groups （Group A： 49%, 51% ; Group C：43%, 51% ） （all P 〈0.05）. The corresponding data in Group A and Group C had no statistically significant difference （P 〉 0.05）. GOS in Group B [ （4.8 ± 1.9） points ] was significantly higher than that in Group A [ （3.3 ±0.2）points] （all P 〈0. 05） within 30 days after admission and significantly higher than that of itself at the beginning [ （3.6± 1.1 ） points ] （ P 〈 0.05 ）. The APACHE Ⅱ in Group A was significantly higher than those in other two groups as well as that in Group A at admission （ P 〈 0. 05）. Mortality rates in Group B （31%） and Group C （29%） were significantly lower than that in Group A （69%） within 30 days after admission （ P 〈 0.05 ）. Conclusions Thyroxine can reduce the incidence of hypotension, liver and kidney injury rate in extremely severe TBI. Prevention is better than the supplementary treatment after severe TBI. Thyroxine can also reduce the mortality of extremely severe TBI within 30 days after admission.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2017年第12期1100-1104,共5页
Chinese Journal of Trauma
基金
广东省自然科学基金（S2013010015328）
关键词
甲状腺素
脑损伤
低血压
病死率
Thyroxine
Brain injuries
Hypotension
Mortality
