転帰からみた重症頭部外傷の現状および死亡要因と転帰不良要因の解析：頭部外傷データバンク【プロジェクト2009】から

抄録

Project 2009 of Japan Neurotrauma Data Bank was conducted from July 2009 to June 2011. We summarized the recent trends of severe head injury view from the outcome, and analyzed the factors of death and unfavorable outcome from the patients in Project 2009. Among 1,091 cases registered, 766 cases with Glasgow Coma Scale (GCS) score 8 or less on admission were classified 3 groups, including survival-good (SG) group (148 cases in good recovery and moderate disability), survival-poor (SP) group (223 cases in severe disability and vegetative state), and dead (D) group (395 cases). The factors of death were analyzed in all 766 cases, and factors of unfavorable outcome were analyzed in 371 cases of survival group (SG + SP). The factors were made from the same viewpoints as Project 2004, including age, sex, the causes of accident, GCS of admission, pupil abnormality, systolic blood pressure, heart rate, respiratory rate, body temperature, pH, PaO2, PaCO2, glucose, cranial CT findings (diffuse injury or mass lesion, pneumocephalus, foreign body, subaracnoid hemor­rhage, intraventricular hemorrhage), Injury Severity Score (ISS), Abbrebiated Injury Score (AIS), and treatment methods (hyperventilation, hypo and normothermia, intracranial pressure monitoring). These factors were included in the multiple logistic regression analysis.

The age (over 60 y/o), M score of GCS (less than 2), anisocor­ia, heart rate (less than 60 /min), PaCO2 (less than 37 torr), glucose (over 200 mg/dl), pneumocephalus, ISS (over 26), AIS of head and neck (over 5), and non indication of intracranial pressure monitoring were the factors of death statistically significantly. And the age (over 40 y/o), anisocoria, PaCO2 (less than 37 torr), glucose (over 200 mg/dl), intraventricular hemorrhage, and ISS (over 25) were the factors of unfavorable outcome statistically siginificantly in the severe head trauma patients in Project 2009.