末期腎病洗腎病人罹患中重度腦創傷之預後及其影響因子

Prognosis and influential factors in end-stage renal disease patients after moderate or severe traumatic brain injury

謝元貴(Yuan-Kuei Hsieh)

指導教授 ： 邱文達

臺北醫學大學/公共衛生暨營養學院/傷害防治學研究所/碩士(2014年)

摘要

我們回溯調查2010-2011年於台南奇美醫學中心住院治療的單純中重度頭部外傷的病患共170位，並將之分成末期腎病洗腎組及非洗腎組，其中末期腎病洗腎組患者有9位，非洗腎組患者有161位。因末期腎病洗腎患者數量較少，故我們依據洗腎組病患之性別及年齡與非洗腎病患(對照組)採取1:4的配對方法做統計分析，我們比較了兩組病患的疾病史、入院之意識狀態及神經學檢查、血液檢查、用藥、30天死亡率及預後等等資料。末期腎病洗腎組病患在入院的血紅素偏低(10.87 vs 13.37 g/dL, p<0.005 )、血糖值明顯偏高(288.56 vs 169.41 mg/dL, p<0.005)，藥物使用方面洗腎組患者在 mannitol 的使用率偏低 (33.33% v 80.56%, p<0.05)但在抗癲癇藥物使用率較對照組來的高(77.78% vs 25.71%, p<0.05)；預後方面，9位洗腎患者當中有6位在事故後30天內死亡，相較於對照組有較高的30天內死亡率(66.67% vs 16.67%, p<0.05)，針對預後的分析方面，洗腎患者在中重度頭部外傷後有較高的比率造成不良的預後(88.89% vs 41.67%, p<0.05)。結論，末期腎病洗腎患者在罹患中重度頭部外傷後與非洗腎族群患者比較起來有較高的30天內死亡率及較差的預後。

關鍵字

頭部外傷 ； 腎衰竭 ； 末期腎病 ； 預後

並列摘要

We retrospectively investigated the prognosis and risk factor for moderate to severe traumatic brain injury (TBI) event in patients with end-stage renal disease (ESRD) who received maintenance hemodialysis (HD) and were admitted to our neurosurgical intensive care unit (ICU) during January 2010 and December 2011 at Chi-Mei medical center in Tainan, Taiwan. Of the170 patients with isolated moderate to severe TBI, 9 of them were ESRD under HD (study group), the rest 161 of them were non-ESRD patients. We compared the medical history, consciousness, neurologic examination, laboratory values, medication, 30-day mortality and outcome in 9 patients with ESRD and a control group (36 patients) matched in gender and age. The ESRD patients group had lower hemoglobin (10.87 vs 13.37 g/dL, p<0.005 ) and higher blood sugar (288.56 vs 169.41 mg/dL, p<0.005) when admission. In the aspect of medication, the mannitol was less used in study group (33.33% vs 80.56%, p<0.05) but anti-epileptic agents were more applied (77.78% vs 25.71%, p<0.05). The 30-day mortality rate was significantly higher in ESRD group (66.67% vs 16.67%, p<0.05) and the ESRD patients had more unfavorable outcome (88.89% vs 41.67%, p<0.05). In conclusion, ESRD patients with moderate to severe TBI had higher 30-day mortality and worse outcome.

並列關鍵字

traumatic brain injury ； renal failure ； end-stage renal disease ； outcome

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