重型颅脑损伤患者并发腹内高压的危险因素及预后分析OA

Objective To investigate the risk factors for intra-abdominal hypertension(IAH)in patients with severetraumatic brain injury(sTBI).Methods A retrospective analysis was conducted in the clinical data of 84 sTBI patients admitted from December 2023 to February 2025.Based on the transvesical pressure measurement method recommended by the World Society of the Abdominal Com-partment Syndrome(WSACS)for diagnosing IAH,the patients were divided into IAH group(n=48)and non-IAH group(n=36).Baseline data,laboratory indicators,and mortality outcomes were compared between the two groups.Univariate and multivariate Logistic regression analyses were used to explore the risk factors for IAH and the 28-day mortality risk,and the receiver operating character-istic(ROC)curve was used to evaluate the predictive value of IAH for mortality risk.Results The incidence of IAH in sTBI patients was 57.1％(48/84).Univariate analysis revealed that the Acute Physiology and Chronic Health Evaluation Ⅱ score,neutrophil ratio,fibrinogen level,and high-sensitivity C-reactive protein level were significantly higher in the IAH group than those in the non-IAH group,while the hemoglobin level was significantly lower in the IAH group(P＜0.05).He-moglobin(OR=0.960,95％CI,0.936 to 0.985,P=0.002)and fibrinogen(OR=2.348,95％CI,1.167 to 4.725,P=0.017)were independent influencing factors for the development of IAH in sTBI patients.The 7-day,28-day,and in-hospital mortality rates in the IAH group were 29.2％(14/48),50.0％(24/48)and 25.0％(12/48)respectively,which were all significantly higher than 2.8％(1/36),13.9％(5/36)and 5.6％(2/36)respectively in the non-IAH group(P=0.002,P＜0.001,P=0.018).Variables with P value less than 0.05 in the univariate analysis were included in the multivariate Logistic regression analysis,which showed that the IAH value was an independent risk factor for 28-day mortality.Specifically,when the IAH value was included in the model as a continuous variable,each 1 mmHg increase was associated with a 23.9％increase in the 28-day mortality risk(OR=1.239,95％CI,1.039 to 1.477,P=0.017).The multivariate a-nalysis also revealed that an elevated high-sensitivity C-reactive protein level(OR=1.016,P=0.039)and a decreased Glasgow Coma Scale(GCS)score(OR=0.367,P＜0.001)were inde-pendently associated with the 28-day mortality risk.ROC curve analysis indicated that IAH had moderate predictive value for 28-day mortality(AUC=0.728)and also had certain predictive value for 7-day mortality(AUC=0.759)and in-hospital mortality(AUC=0.778).Kaplan-Meier surviv-al curve analysis showed that the 28-day survival rate of patients in the IAH group was significantly lower than that in the non-IAH group(P＜0.001).Conclusion The incidence of intra-abdominal hypertension is relatively high in sTBI patients.Decreased hemoglobin and increased fibrinogen are independently associated with the development of IAH,and elevated intra-abdominal pressure is sig-nificantly associated with an increased mortality risk in patients.