重型颅脑创伤患者伤后早期发生阵发性交感兴奋发作的危险因素分析

目的探讨重型颅脑创伤（sTBI）患者伤后早期并发阵发性交感兴奋发作（PSH）的危险因素。方法回顾性分析2017年9月1日—2022年1月19日上海交通大学医学院附属仁济医院神经外科及颅脑创伤中心收治的121例sTBI患者临床资料。根据PSH量表评分进行诊断，统计诊断PSH的患者临床表现。所有患者均采用以α2受体激动剂为基础药物治疗，并根据病情调整用药，其它用药包括苯二氮卓5例，溴隐亭2例，阿片类3例，统计患者治疗结果。采用单因素分析和多因素Logistic回归分析法分析影响伤后早期并发PSH的危险因素。结果121例患者中，共19例患者诊断为PSH，发病时间平均为伤后第29天。19例发生PSH患者的临床表现包括，心率加快17例，高热14例，血压升高14例，呼吸急促13例，大汗淋漓12例，肢体肌肉强直12例。经药物治疗17例患者控制良好，2例症状明显缓解，偶有轻微发作。单因素分析结果显示，年龄，伤因，脑积水，入院血小板及血糖水平是影响患者伤后早期并发PSH的危险因素（均P＜0.05）。多因素Logistic回归分析结果显示，年龄（OR=0.930,95% CI:0.880~0.982，P=0.009），脑积水（OR=105.561,95% CI:9.155~1 217.106，P<0.001）是并发PSH的独立危险因素。结论年轻及合并脑积水的sTBI患者伤后早期更容易并发PSH。

Objective To explore the risk factors associated with early paroxysmal sympathetic hyperactivity(PSH) of severe traumatic brain injury（sTBI） patients. Methods The clinical data of 121 sTBI patients admitted to Department of Neurosurgery and Brain Injury Center, Renji Hospital, School of Medicine, Shanghai Jiao Tong University from Sep 1, 2017 to Jan 19, 2022 were analyzed retrospectively. Diagnosis of PSH were made according to the PSH Assessment Measure(PSH-AM) scores. Clinical features of PSH patients were analyzed. All patients were treated with α2 agonist-based therapeutic scheme and other medicines added according to treatment effects, 5 patients added with benzodiazepine, 2 with bromocriptine and 3 with opioid. Outcomes of treatment were concluded. Univariate analysis and multivariate logistic analysis were made to investigate risk factors. Results 19 were diagnosed(15.70%) with PSH in 121 patients, average onset time was 29 days after injury. Clinical features included tachycardia in 17 patients, hyperpyrexia in 14, hypertension in 14, tachypnea in 13, sweating in 12, ankylosis in 12. After treatment, 17 patients were well-controlled and 2 relieved significantly. Univariate analysis showed that age, injury cause，hydrocephalus，blood platelet and glucose at admission were risk factors(all P<0.05), and multivariate logistic analysis showed that age(OR=0.930,95% CI:0.880-0.982,P=0.009) and hydrocephalus(OR=105.561,95% CI:9.155-1 217.106,P<0.001) were independent risk factors. Conclusion Young patients with hydrocephalus are more likely to develop early PSH after sTBI.