外伤后颅内进展性出血性损伤106例分析

Progressive Hemorrhagic Injury After Traumatic Brain Injury(a Report of 106 Cases)

目的探讨颅脑损伤后进展性出血性损伤(PHI)的发生及影响预后的相关因素。方法对2007年颅脑损伤后出现PHI的106例患者的临床资料进行回顾性分析,并与同期无PHI患者进行对照研究。结果颅脑损伤后是否出现PHI与患者的年龄是否超过50岁(P<0.05)、血浆纤维蛋白原水平是否低于2g/L(P<0.01)及有无蛛网膜下腔出血(SAH)(P<0.05)密切相关。PHI患者的预后与年龄是否超过50岁(P<0.01)、血浆纤维蛋白原水平是否低于2g/L(P<0.01)、有无SAH(P<0.01)及入院时的GCS评分(P<0.01)密切相关。结论PHI最常出现于颅脑伤后12h内,好发于着力点的对冲部位,以额颞部为主,与患者的年龄、血浆纤维蛋白原水平及是否伴有SAH等因素密切相关;其预后与患者的年龄是否超过50岁、入院时GCS评分、血浆纤维蛋白原水平是否低于正常及是否伴有SAH密切相关。

Objective To investigate the risk factors of progressive hemorrhagic injury （PHI） after traumatic brain injury and factor related to the prognosis. Method The clinical data of 106 in patients with PHI, who accounted for 21.5% of 493 patients with traumatic brain injury during the same period, were analyzed retrospectively. Results The risk factors of PHI after traumatic brain injury included age 〉50 years （P〈0.05）, plasma level of fibrinogen 〈2 g/L （P〈0.01） and subarachnoid hemorrhage （P〈0.05）. The prognosis was significantly related with the age （P〈0.01）, plasma level of fibrinogen （P〈0.01）, subarachnoid hemorrhage （P〈0.01） and GCS on admission （P〈0.01） in the patients with PHI after traumatic brain injury. Conclusions PHI mainly occurs within 12 hours after the traumatic brain injury, and it frequently occurs in the frontal lobe, temporal lobe and cerebral area of countercoup of the primary injury. The occurrence of PHI is related with the age, Plasma level of fibrinogen, and subarachnoid hemorrhage. The prognoses are related with the age, plasma level of fibrinogen, subarachnoid hemorrhage and GCS on admission in the patients with PHI after traumatic brain injury.