颅脑损伤患者手术预后因素回归分析

Regression analysis of the factors affecting the prognosis of operated patients with head injury

目的探讨颅脑损伤手术病人手术结果与术前诸多影响因素之间的关系。方法采用回顾性方法，收集148例患者临床资料，整理并输入EXCEL表格。将性别、年龄、入院时GCS评分、是否急诊气管切开、血肿量及类型、中线移位程度等分析指标以及手术结果（以GOS表示）赋值量化后用SPSS11．0统计包进行一系列统计学处理，得出有意义指标及多元回归方程。结果单因素分析表明手术预后与血肿量大小、中线移位程度、入院时GCS评分、硬膜下血肿存在与否、硬膜外血肿存在与否、是否存在脑肿胀有关。但多元逐步回归分析结果表明手术预后仅与入院时GCS评分、硬膜下血肿存在与否、血肿量大小、是否合并脑肿胀显著相关。结论临床颅脑损伤手术结果与多因素有关，它们之间并非互相独立而是彼此影响的。但临床工作中更应注意入院时GCS评分、硬膜下血肿存在与否、血肿量大小、是否合并脑肿胀这4个影响因素。

Objective To analyze the clinical factors affecting the prognosis of operated patients with head injury. Methods A retrospective analysis was conducted on the clinical data of 148 patients with head injury who had been operated between January and December 2004 in our hospital. The factors included sex, age, GCS scores on admission, emergency tracheotomy, hematoma volume, shift of midline, types of hematoma, brain contusion and laceration and brain swelling. The prognosis （GOS on discharge） and these factors was analyzed by linear regression and stepwise regression with SPSS 11.0. Results The linear regression analysis showed that the prognosis was statistically associated with hematoma volume, shift ofmedline, GCS scores on admission, subdural hematoma, extradural hematoma and brain swelling. The stepwise regression analysis showed that the prognosis only had statistical correlation with hematoma volume, GCS scores on admission, subdural hematoma and brain swelling. Conclusion Multiple factors exert synergic effect on the therapeutic outcomes of the patients with head injury. The 4 factors, GCS scores on admission, subdural hematoma, hematoma volume and brain swelling should be paid much attention on in the clinical treatment.