重型颅脑损伤患者预后相关因素分析

Anolysis of related factors about prognosis of patients with Severey Traumatic Brain Injury

目的分析评价影响重度脑损伤、颅内血肿．脑疝患者的预后因素。方法回顾性分析84例手术治疗的重型脑外伤并发颅内血肿一脑疝患者的临床随访资料，对患者年龄、GCS评分、瞳孔光反应、中线偏移、脑池压缩、减压时间及有无合并伤等因素与患者预后的关系作分组比较分析，并用Logistic回归分析的方法，分析各因素与患者预后的关系。结果84例中36里存活，48例死亡；28例（33％）预后良好，56例（67％）预后不良，减压时间在3h以内者预后明显优于超过3h者，死亡率分别为11％和67％（x^2=22．92，P〈0．01）。脑池压缩闭塞程度轻者预后优于脑池压缩闭塞重者（P〈0．01），Logistic回归方程分析发现，手术减压时间可对90．5％的患者预后做出正确预测，手术减压时间和脑池压缩程度联合可对95．2％的患者预后做出正确预测。结论重度脑损伤并发脑疝患者死亡率高，手术干预治疗效果确切。手术减压时间长短和脑池压缩闭塞程度是影响颅内血肿-脑疝患者预后的最重要因素，二者可对患者预后做出较准确预测。

Objective To evaluate prognostic indicators in severe traumatic brain injury and intracania hamatomas with hernia and analyze which is the most important indicator. Methods Data of 84 cases with severe traumatic brain injury were retrospectively analyze. Age, GCS, pupil reflex, midline shift, compression of the eisterne, decompression time and complex injury were considered as possible prognostic indicators. SPSS13.0 was employed to analyze the data,Logistic regression（ Forward conditional） analysis was done to confinn which are the most important prognostic indicators for severe traumatic brain injury and to evaluate the practical value in predicting prognosis （ x^2 = 22. 92, P 〈 0. 01 ）. Results 48 patients died and 36 survived. 56 （67%） patients had a bad prognosis （ GCS ≤ 3 ） and 28 （33%） had a good prognosis（ GCS 〉 3 ）. Those who had a shorter decompression time（≤3h） had a better progno- sis than those who had a longer decompression time（ 〉 3h）, with the mortality rate of 11% and 67% respectively. Lesser cisternc compression predicts better outcome. GCS, pupil reflex, midline shift, and complex injury didn＇t enter the logistic regression equation. According to compression time ,90.5% of the eases＇ prognosis was accurately predicted,according to compression time and eisterne compression,95.2% was accurately predicted. Conclusion The mortality rate of severe traumatic brain injury with hernia was high and surgical intervention was effective. Decompression time and eisterne compression were the most important factors affecting prognosis in severe traumatic brain injury and they could predict prognosis of most eases correctly.