Kết quả điều trị và yếu tố tiên lượng nguy cơ tử vong của bệnh nhân chấn thương sọ não nặng tại bệnh viện Việt Đức





!"#$%&'()!*+,-.
/(0123456,.7809
34(4(4$

:;$?@AB:;C?DEF=


3GHIJKLMNOPQ67R5SN
5KONTJQUVWHXQYOZQON[JJO\]^O_JY`QOQaQbcVYdeJOOHfJKWcJYgh[YijkJKjRlcYmVeWNnVYGo
Qpqr[JOJO_JQOsJYOHtJKuPJvkJwJK943x55uqVyYOaJKQOsJYOHtJKz{cYmVeQOkYOsbYgh[YijkJK
2|8}|WaJOKNa]UQWSO~N^OQuqVyYOaJKYO€k‚xQƒ
y|1} Qƒ„NQOUJK]UQWSj…qOkwQO~N^OQ
YdY9‚x2jR†jRy
|
}Qƒ„NQOUJKJwJK|udJKYOZQj‡YOkwQYijkJK9‚xˆ
z3gh[YijkJKQqkfQaQ
JOƒ] lO‰JKWSN]ŠrekON‹] 9^Œ|1‚ŽŒ2|2
4|

y|‘†|JOƒ] O‰J]Tu_V9^Œ|1
‚ŽŒ
|18
4|
†|‘‘z3gh[YijkJKQqkfJOƒ]QOsJYOHtJKuPJvkJwJKlO‰JKWSN]ŠrekON‹]|
O‰J]Tu_V|KNvJW~JKYi
rTJ|Y’JYOHtJKJvkhqJY“qWS|”jRJOƒ]Y’JYOHtJKJvkWv]’OkwQQOHq
]’YGTJ^ON]Q•Yh–^jNY`JOQƒlOdN]aVY—
†]hYO€k^O_JhkMN˜qGuOqhhzLNnVYGoJSNlOkq^OdNOX^WNnVYGo
^O™VYOV‡Ylo^YOINlONa^hZQJSNuPYšJKJO\]hR]KNe]Y›h[YijkJKjRrNcJQOUJKz
œCžŸ ¡C¢=£C;¤¥=¦§=¨=>BE©ª£«£@F=¬;­=>B£®¬¯£°±§=>B²³¬´¡=µ@¤¥

º$9(6$%

»¼½¾¿À¼Á¾ÿÄÅ¿¾ÆÇ¿ÈÉ¿ÊËÀ¿Ì½Í¿ÌÎÏ¿¾ÃÇÐÑ¿
Ò¼ÇÓ¿À¼ÁԾÿÃÕÍÖ¿×Ø¿ÈÁپÿÚÛ¾¼¿¾¼Ü¾¿Ý½À¿
È޾߿àÑáÏ¿ÀÝâ¿Àؾ¿ÒãÊß¿äѿ̼ξÿåÉ¿Àæ¿åǾÿÌÓÇÖ¿
»¼½¾¿À¼Á¾ÿÄÅ¿¾ÆÇ¿ÈÏ羿ÈÉ¿å½¾¿àá¿ÈÞ¾¿è¿Ú½À¿
ÌοéÏØÌ¿ÃÑÓ¿¾ÉÇÖ¿êæ¿åǾÿäǿ̼½¾¿À¼Á¾ÿÄÅ¿
¾ÆÇ¿àξÿ¼É¾Ã¿À¼Î¿ë¿Ì¼ì¿íîÍ¿ÄÓÏ¿Àæ¿åǾÿäÇ¿
ÚÛ¾¼¿ÀÑÊ¿ÊÐ̼¿åÉ¿ÚÛ¾¼¿Ï¾Ã¿À¼ÁÖ¿ï¿ÌðÌ¿¾ÁÞÌ¿
»¼ÜÏ¿ñÏß¿ÀÝϾÿÚò¾¼¿ÊóÑ¿¾ôÊ¿Ìõ¿Ò¼Çö¾Ã¿÷øùù¿
¾ÃÁÔÑ¿ÀÝú¾¿÷ùùÖùùù¿äܾ¿àҼðÊ¿ÀÐÑ¿ÌðÌ¿Ì¿
Äè¿û¿Àî¿åò¿Ì¼½¾¿À¼Á¾ÿÄÅ¿¾ÆÇ¿åÉ¿Ò¼Çö¾Ã¿÷üø¿
ÄØ¿ÚÛ¾¼¿¾¼Ü¾¿¾Éû¿Í¼öÑ¿åÉÇ¿åÑÛ¾¿àÑáÏ¿ÀÝâ¿ý÷þ¿ÿ0Ö¿
»¼½¾¿À¼Á¾ÿÄÅ¿¾ÆÇ¿ÈÉ¿¾ÃÏûú¾¿¾¼Ü¾¿¼É¾Ã¿
à1Ï¿ä2¾¿àÀæ¿åǾÿåÉ¿Àɾ¿Í¼î¿äǿ̼½¾¿
À¼Á¾ÿè¿ÈÎÓ¿ÀÏ3Ñ¿ÀÝÁè¾Ã¿À¼É¾¼Öê¼4Ç¿ê3¿Ì¼ÎÌ¿
5¿Àî¿ê¼î¿ÃÑÞÑß¿¼É¾Ã¿¾ôÊ¿ÀÝú¾¿ÀÇɾ¿À¼î¿ÃÑÞÑ¿Ìõ¿
Ò¼Çö¾Ã¿÷ù¿ÀÝÑÛÏ¿Ìӿ̼½¾¿À¼Á¾ÿÄÅ¿¾ÆǿͼöÑ¿
¾¼6Í¿åÑÛ¾¿àÑáÏ¿ÀÝâß¿ÀÝǾÿÄØ¿àõ¿Ìõ¿À7¿ÈÛ¿Ò¼ç¾Ã¿

¾¼8¿ÚÛ¾¼¿¾¼Ü¾¿ÊӾÿäѿ̼ξÿÈÜÏ¿äÉÑ¿¼ÇÕÌ¿Àæ¿
åǾÃÖ¿ê¼Ø¾Ã¿Òú¿Ì9Ó¿êÝϾÿÀÜÊ¿ÒÑ
Ê¿ÄÇðÀ¿ÚÛ¾¼¿
À6À¿ÇÓ¿Ò¿
»4¾À4ÝÄ¿ÇÝ¿äÑÄ4ÓÄ4¿ÌǾÀÝÇÈ¿¿»»¿
¼É¾Ã¿¾ôÊ¿Ìõ¿÷ßø¿ÀÝÑÛÏ¿Ìӿ̼½¾¿À¼Á¾ÿÄÅ¿¾ÆÇ¿
ͼöÑ¿¾¼6Í¿åÑÛ¾Ö¿ÞÌ¿À¾¼¿Ìõ¿øÿÖùùù¿ÀÝÁԾÿ
¼ÙÍ¿Àæ¿åǾÿäǿ̼½¾¿À¼Á¾ÿÄÅ¿¾ÆÇ¿¼É¾Ã¿
¾ôÊ¿åÉ¿Ìõ¿ùÖùùù¿¿ùÖùùù¿Úâ¿äѿ̼ξÿÀɾ¿
ͼî¿ÈÜÏ¿äÉÑÖ¿»¼Ñ¿Í¼¿Ì¼Ç¿Ì¼½¾¿À¼Á¾ÿÄÅ¿¾ÆÇ¿
ÀÐÑ¿ÇÓ¿¿¾ôÊ¿ÿùù¿Èú¾¿ÀÞÑ¿ù¿À7¿äÇÈÈÓÝÄÖ¿ï¿
̼ÜÏ¿ñÏ¿Àì¿ÈÛ¿¾Éû¿ÈÉ¿÷ß¿ÀÝÑÛÏ¿Ìӿ̼½¾¿À¼Á¾ÿ
ÄÅ¿¾ÆÇ¿åÉ¿Öùùù¿ÀÝÁԾÿ¼ÙÍ¿Àæ¿åǾÿ¼É¾Ã¿
¾ôÊ¿ý÷þ¿ÿ0ֿ￾ÁÞÌ¿ÀÓ߿̼½¾¿À¼Á¾ÿÄÅ¿¾ÆÇ¿ÈÉ¿
ÊËÀ¿å½¾¿àá¿ÈÞ¾¿Ò¼ç¾Ã¿Ì¼ì¿ÝÑú¾Ã¿Ì9Ó¿¾Ãɾ¼¿û¿
Àîß¿Êɿ̾¿ÈÉ¿Ì9Ó¿ÀÇɾ¿íÆ¿¼ËÑß¿åò¿¾ÃÏûú¾¿¾¼Ü¾¿
̼9¿ûîÏ¿ÈÉ¿äÇ¿ÀÓÑ¿¾Ð¾¿ÃÑÓÇ¿À¼ç¾ÃÖ¿»¾Ã¿¾¼Á¿
ÀÝú¾¿À¼î¿ÃÑÞÑß¿àÓ¿ÄØ¿ÚÛ¾¼¿¾¼Ü¾¿è¿àË¿ÀÏ3ѿ̾¿
ݽÀ¿ÀÝÖ¿ê¼4Ç¿¾¼¾Ã¿À¼Ø¾Ã¿Òú¿Ã1¾¿àÜû߿̼½¾¿
À¼Á¾ÿÄÅ¿¾ÆÇ¿¿ÀÓÑ¿¾Ð¾¿ÃÑÓÇ¿À¼ç¾Ã¿Ìõ¿Àì¿ÈÛ¿ÌÓÇ¿
LoqQOghNTJO[¶HtJKLMN7R|rS]‰J5KkMN|YGHIJKLMN àù¿¿ùÖ¿×Ø¿ÚÛ¾¼¿¾¼Ü¾¿Ì½Í¿ÌÎÏ¿ÄÅ¿¾ÆÇ¿
OPQ67R5SN
Àô¾Ã¿Èú¾¿¼É¾Ã¿¾ôÊß¿Àì¿ÈÛ¿Àæ¿åǾÿ̼ÑîÊ¿¿
·€]qNh„VkJK„qNOq¸K]qNhzQk]
À3¾Ã¿ÄØ¿ÌðÌ¿Àæ¿åǾÿäÇ¿ÀÓÑ¿¾Ð¾¿¾õѿ̼Ͼÿýë0Ö¿
JKRbJO‡J
¹
¹
2
5KRbWHXQQOs^YOV‡J
y¹y¹
2
ÎÌ¿àË¿¾Õ¾Ã¿Ì9ӿ̼½¾¿À¼Á¾ÿÄÅ¿¾ÆÇ¿äÓ¿
12

345467889

2

!"#$%&#'()&#*+,#-!./#012#34.'#56(#57./#'8.#
,9#:*;-/"'M.'#r#
sio#012#34.'#7.'#'D6./#2V;#.'p./#iR&#Bq#
.;i#3q(# L(#B(9.#*Da./#5).'#.'+.#2'%.#
B'DE./#-G#.O"#*!#2E#-6#3c#3PB#H;#,I2#B(9&#
3(d&#BH4#2'"#5).'#.'+.#2'%.#B'DE./#-G#.O"#
.P./N#>'w./#B8(#B(R.#'!.'#./'(9.#2j&#.!i#
.'h,#,I2#B(9&x##
y1.'#/(1#fRB#b&7#3(d&#BH4#2'%.#B'DE./#-G#
.O"#.P./N#
z12#34.'#,FB#-q#iR&#Bq#7.'#'D6./#3R.#BX#
"./#!#fRB#b&7#J'I2#'{(#2V;#5).'#.'+.#-;&#
3(d&#BH4#2'%.#B'DE./#-G#.O"#.P./#Bm(#5).'#
().#u()B#yj2N#

|}~€‚ƒ„

…|}†‡ˆ‰Š‹Œ./'(9.#2j&#3Da2#B(R.#'!.'#
BH9.#S]T#5).'#.'+.#2'%.#B'DE./#-G#.O"#.P./#
3(d&#BH4#Bm(#5).'#().#u()B#yj2#BH"./#/(;(#3"m.#
BŽ#B'1./#S]TSS#3R.#B'1./#]TSSN#


‘’“”•–—”˜™•š›œ•–—™ž•5).'#.'+.#2'%.#
B'DE./#-G#.O"#.P./#:>?#Ÿ# #3(c,#3(d&#BH4#Bm(#
f'";#¡'¢&#B'&sB#£'n.#f(.'#!#¤{(#-j2#£M2'#2l2#
5).'#().#u()B#yj2#
3Da2#3D;#!"#./'(9.#2j&N#
>'IJ#2KB#*LJ#(#BM.'#-G#.O"^#2W#3ni#3V#
B'8./#B(.#BH"./#'{#-E#5).'#1.N#
‘’“”•–—”˜™•š¥¦’•§¨©x#5).'#.'+.#2'%.#
B'DE./#-G#.O"#,!#:>?#ª# o#2'%.#B'DE./#-G#
.O"#.'D./#f«,#B'@"#212#B'DE./#BC.#J'q(#'aJ#
f'12x#5I./o#./l2o#2FB#-q./o#f«,#B'@"#5).'#
B(,#J'C(#,m.#BM.'o#31(#3Dg./o#-&i#B's.N#
¬|­‰®‹Œ¯­°¯./'(9.#2j&#,8#B7#2KB#
./;./#B(R.#2j&N#
‘—±™²•§’™•™²—’“™•–³”••
´µ(#5).'#.'+.#3d&#2W#S#J'(R&#./'(9.#2j&#
3c#B'&#B'sJ#-q#*()&#2W#BH"./#'{#-E#5).'#1.#fc#
BŽ#f'(#!"#(9.#2'"#3R.#'RB#b&1#BHr.'#3(d&#BH4N#
>12#B';,#-q#./'(9.#2j"#/{,x#¶R&#Bq#$42'#
B·#'G2#*+,#-!./#2V;#5).'#.'+.x#=B&C(#/(L(o#
./&i9.#.'+.#07i#H;#B;(#.m.o#,¸#57"#'(c,A#Br.'#
BHm./#BC.#B'DE./#-G#.O"#=,j2#3F#'8.#,9#B'@"#
B';./#3(c,#:>?o#Br.'#BHm./#3{./#BXo#'r.'#7.'#
BC.#B'DE./#BH9.#J'(,#2KB#*LJ#(#BM.'#-G#.O"#
J'+.#*"m(#B'@"#´;H-';**Ao#3"#1J#*l2#.F(#-GN#>12#
5().#J'1J#3(d&#BH4#3O#3Da2#1J#$I./o#B(R.#BH(c.#
!#31J#j./#2V;#5).'#.'+.#-;&#3(d&#BH4N#
>12#5).'#.'+.#2'RB#Bm(#5).'#().#'"P2#H;#
().# r#Br.'#BHm./#.P./#f'8./#2'p;#3Da2#
3Da2#0@,#*!#BX#"./N#
y1.'#/(1#fRB#b&7#3(d&#BH4#f'(#H;#().#!#-;&#
#B'1./#B'@"#B';./#3(c,#:*;-/"?MCBMDE;
NF;
OPKL>QJ;
@F;
MC;
F
IJKL>
OPKL>QJ>

gd'5![5Ub'ef)'
?MMBNDE>
F?GGBGDE>
GM>

gd'5![fh'a!aij'5
M>?FNBFDE>
?=
G@>

4'5*6
GH>
AF>
NF>

Ok>lm>:n>opKL>K8qr>smK8>K8tK>LuvK>wxKL>:n>syK>z{p>8|K>K8qr>smK8>K8tK>}8~KL>LuvK>wxKL>
:n>?>€>HBHHH@>‚ƒ>„>CBMMN>7…†>GBF@M>‡>>
R$'5‰STU)'"#V'5UWV!XYZ![\]'5\^(Š‹cŒ!4'!ai'5!Ž)'‹!Y‘\U!’'a
 !"#$
789:>
IJKL>
OPKL>QJ>

4'!ai'5YV'!“V”•
?NHDE>
F?GHDE>
AH>

4'!ai'5YV'!“V”
M>?F
A?=NB@DE>
A=>

4'5*6
GA>
@A>
==>

Ok>lm>:n>opKL>–>K8qr>smK8>K8tK>zq>}9:>—˜™>zš:>l›>ou>:œK8>Q>Kvp>lž>:PK>:8Ÿ|KL>l{K>: {>………B>…¡>
z{p>8|K>K8qr>:PK>:8Ÿ|KL>l{K>: {>…B>……>?>€>HBHHH@>‚ƒ>„>FMBGGG>7…†>@BA=C>‡>A=BMHHEˆ>
R$'50STU)'"#V'5UWV¢ !"#$cU£#!Ž¤\^c]¥‘Y¦‹!Ž]'5*§,1
 !"#$%
©‚I>„>F„>A@;
OPKL>QJ;

a&'5c]%
MH>?MCB=DE;
?GHB?ANBFDE;
F=>?@GBCDE;
GA;

4'5*6%
NM;
AA;
FK8tK>zq>wp>«>l¬z>K­u>Q>zq>}9:>—˜™>wu®˜>:¯°>:J:>8|K>K8qr>smK8>K8tK>}8~KL>wp>«>l¬z>
K­u>Q>?>„>HBH„>7…†>FBFA=>‡>@B=MCEˆ






































234356

















7

7


8
9


































































































































24B7>Ds7>4567WLŽ6278