JAMA Neurol:脑损伤患者高碳酸血症、高碳酸中毒与院内死亡风险研究

2018-03-22 zhangfan MedSci原创

研究发现脑损伤伴高碳酸中毒患者死亡风险增加,脑损伤24小时内代偿性高碳酸血症患者的死亡风险与血碳酸和pH正常患者的差异不显著

急性脑损伤患者血碳酸过多以及高碳酸中毒对预后的影响研究尚不充分,近日研究人员考察了急性脑损伤后24小时高碳酸血症、高碳酸中毒与患者死亡之间的关系。

因外伤性脑损伤、心脏骤停和中风导致脑损伤患者参与研究,依据患者脑损伤后24小时动脉血pH和动脉二氧化碳压进行分层,研究的主要终点是院内死亡率。

30742名患者参与研究,患者平均年龄55岁,男性占71%。未经调整发现,高碳酸中毒患者院内死亡风险最高。多变量逻辑回归分析与Cox比例风险分析发现,相比于血碳酸和pH正常患者,高碳酸中毒患者发生心脏停搏、中风以及外伤性脑损伤患者的比值比分别为1.51、1.43以及1.22,死亡风险分别为1.23、1.3以及1.13。24小时内代偿性高碳酸血症患者相比于血碳酸和pH正常患者死亡率无显著性差异。

研究发现脑损伤伴高碳酸中毒患者死亡风险增加,脑损伤24小时内代偿性高碳酸血症患者的死亡风险与血碳酸和pH正常患者的差异不显著。

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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/28/a28e8ea268716dfc601012321847bccf.jpg, createdBy=e21a1620364, createdName=清氺訫, createdTime=Wed Mar 28 11:32:09 CST 2018, time=2018-03-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1255741, encodeId=17b41255e4111, content=<a href='/topic/show?id=587f6339050' target=_blank style='color:#2F92EE;'>#死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63390, encryptionId=587f6339050, topicName=死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Sat Mar 24 02:10:00 CST 2018, time=2018-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1319071, encodeId=8fe213190e1df, content=<a href='/topic/show?id=14d92231508' target=_blank style='color:#2F92EE;'>#中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22315, encryptionId=14d92231508, topicName=中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f13d475, createdName=mashirong, createdTime=Sat Mar 24 02:10:00 CST 2018, time=2018-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1397503, encodeId=a81c139e503f2, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Sat Mar 24 02:10:00 CST 2018, time=2018-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1585983, encodeId=e85d1585983ea, content=<a href='/topic/show?id=30e110253124' target=_blank style='color:#2F92EE;'>#高碳酸血症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102531, encryptionId=30e110253124, topicName=高碳酸血症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=aff417344311, createdName=lvygwyt2787, createdTime=Sat Mar 24 02:10:00 CST 2018, time=2018-03-24, status=1, ipAttribution=)]
    2018-09-10 yinhl1978
  5. 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target=_blank style='color:#2F92EE;'>#中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22315, encryptionId=14d92231508, topicName=中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f13d475, createdName=mashirong, createdTime=Sat Mar 24 02:10:00 CST 2018, time=2018-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1397503, encodeId=a81c139e503f2, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Sat Mar 24 02:10:00 CST 2018, time=2018-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1585983, encodeId=e85d1585983ea, content=<a href='/topic/show?id=30e110253124' target=_blank style='color:#2F92EE;'>#高碳酸血症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102531, encryptionId=30e110253124, topicName=高碳酸血症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=aff417344311, createdName=lvygwyt2787, createdTime=Sat Mar 24 02:10:00 CST 2018, time=2018-03-24, status=1, ipAttribution=)]
    2018-08-14 1e145228m78(暂无匿称)

    学习了,谢谢作者分享!

    0

  6. 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topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Mon Sep 10 09:10:00 CST 2018, time=2018-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=338590, encodeId=b413338590ca, content=学习了,谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Tue Aug 14 22:05:57 CST 2018, time=2018-08-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300488, encodeId=1761300488e5, content=学习了--, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, 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target=_blank style='color:#2F92EE;'>#中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22315, encryptionId=14d92231508, topicName=中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f13d475, createdName=mashirong, createdTime=Sat Mar 24 02:10:00 CST 2018, time=2018-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1397503, encodeId=a81c139e503f2, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Sat Mar 24 02:10:00 CST 2018, time=2018-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1585983, encodeId=e85d1585983ea, content=<a href='/topic/show?id=30e110253124' target=_blank style='color:#2F92EE;'>#高碳酸血症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102531, encryptionId=30e110253124, topicName=高碳酸血症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=aff417344311, createdName=lvygwyt2787, createdTime=Sat Mar 24 02:10:00 CST 2018, time=2018-03-24, status=1, ipAttribution=)]
    2018-03-28 清氺訫

    学习了--

    0

  7. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/28/a28e8ea268716dfc601012321847bccf.jpg, createdBy=e21a1620364, createdName=清氺訫, createdTime=Wed Mar 28 11:32:09 CST 2018, time=2018-03-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1255741, encodeId=17b41255e4111, content=<a href='/topic/show?id=587f6339050' target=_blank style='color:#2F92EE;'>#死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63390, encryptionId=587f6339050, topicName=死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Sat Mar 24 02:10:00 CST 2018, time=2018-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1319071, encodeId=8fe213190e1df, content=<a href='/topic/show?id=14d92231508' target=_blank style='color:#2F92EE;'>#中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22315, encryptionId=14d92231508, topicName=中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f13d475, createdName=mashirong, createdTime=Sat Mar 24 02:10:00 CST 2018, time=2018-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1397503, encodeId=a81c139e503f2, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, 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  8. [GetPortalCommentsPageByObjectIdResponse(id=1635240, encodeId=3b9d1635240e3, content=<a href='/topic/show?id=bb41983049e' target=_blank style='color:#2F92EE;'>#院内死亡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98304, encryptionId=bb41983049e, topicName=院内死亡)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=78f122436081, createdName=yuhaisheng_ibp_32061718, createdTime=Fri Feb 22 01:10:00 CST 2019, time=2019-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2055625, encodeId=a37c2055625d8, content=<a href='/topic/show?id=734110089320' target=_blank style='color:#2F92EE;'>#风险研究#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100893, encryptionId=734110089320, topicName=风险研究)], attachment=null, authenticateStatus=null, 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/28/a28e8ea268716dfc601012321847bccf.jpg, createdBy=e21a1620364, createdName=清氺訫, createdTime=Wed Mar 28 11:32:09 CST 2018, time=2018-03-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1255741, encodeId=17b41255e4111, content=<a href='/topic/show?id=587f6339050' target=_blank style='color:#2F92EE;'>#死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63390, encryptionId=587f6339050, topicName=死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Sat Mar 24 02:10:00 CST 2018, time=2018-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1319071, encodeId=8fe213190e1df, content=<a href='/topic/show?id=14d92231508' target=_blank style='color:#2F92EE;'>#中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22315, encryptionId=14d92231508, topicName=中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f13d475, createdName=mashirong, createdTime=Sat Mar 24 02:10:00 CST 2018, time=2018-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1397503, encodeId=a81c139e503f2, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Sat Mar 24 02:10:00 CST 2018, time=2018-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1585983, encodeId=e85d1585983ea, content=<a href='/topic/show?id=30e110253124' target=_blank style='color:#2F92EE;'>#高碳酸血症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102531, encryptionId=30e110253124, topicName=高碳酸血症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=aff417344311, createdName=lvygwyt2787, createdTime=Sat Mar 24 02:10:00 CST 2018, time=2018-03-24, status=1, ipAttribution=)]
    2018-03-24 mashirong
  9. 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  10. 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