急性颅脑创伤后进展性颅内出血发生的

Risk factors and prognosis of progressive intracranial hemorrhage in patients with acute traumatic brain injury

目的 分析急性颅脑创伤后进展性颅内出血（progressive intracranial hemorrhage,PIH）发生的危险因素及临床意义.方法 通过比较颅脑创伤患者连续头颅CT扫描的表现,确定是否发生PIH.分析PIH与非PIH患者在年龄、性别、受伤机制、入院时GCS、受伤至首次CT检查时间、首次CT检查表现、伤后早期血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（Fg）、凝血酶时间（TT）、血小板（PLT）、D-二聚体（D-D）的含量等方面的差异,并采用Logistic回归分析PIH发生的危险因素.结果 共纳入498例患者,其中139例（27.9%）发生PIH.116例（83.5%）PIH在伤后2 h内行CT扫描.PIH组与非PIH组在年龄、入院时GCS、受伤至首次CT扫描时间、伤后首次CT表现为骨折、蛛网膜下腔出血（SAH）、挫裂伤、初发血肿、血浆PT、Fg、D-D含量差异有统计学意义（P＜0.01）.Logistic多元回归分析显示,PIH组与非PIH组在伤后CT表现为SAH、挫裂伤、初发血肿以及D-D与PIH的发生密切相关（P＜0.01）.结论 对于受伤后早期（2 h内）即行首次头颅CT检查的患者,如果首次CT表现为SAH、挫裂伤、初发血肿合并D-D含量升高,应进行更早的连续CT扫描以期早期发现PIH.

Objective To investigate the risk factors related to progressive intracranial hemorrhage （PIH） in patients with acute traumatic brain injury （TBI） and analyze their clinical significance.Methods PIH was validated by comparing the initial and repeated CT scans. Data including gender,age, injury causes, Glasgow Coma Score （GCS） on admission, time interval from injury to the first CT scan, initial CT scan manifestations, prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrinogen （Fg）, thrombin time （TT）, platelet （PLT） and D-dimer （D-D） in both groups were compared with Logistic regression analysis to observe the risk factors related to PIH. Results The study involved 498 patients with acute TBI, of which 139 （27.91%） patients suffered from PIH. There were 116 patients （83.45%） with PIH who received the initial CT scan within two hours post injury.There was statistical difference in aspects of age, GCS on admission, time interval from injury to the first CT scan, initial CT scan manifestations （ including fractures, subarachnoid hematoma, contusion and onset hematoma）, PT, Fg and D-D values in both groups （P 〈0.01 ）. Logistic regression analysis showed that CT scans （subarachnoid hemorrhage, brain contusion and primary hematoma） and plasma D-D values were predictors of PIH （ P 〈 0.01 ）. Conclusions For patients with the initial CT scan manifestations including subarachnoid hemorrhage, brain contusion, primary hematoma together with D-D value increase within two hours post injury, a continuous CT scan should be performed promptly to detect PIH early.