中重型颅脑损伤后进展性出血性损伤危险因素的Logistic回归分析

Logistic regression analysis of the risk factors in progressive hemorrhagic injury after severe head injury

目的 探讨中重型颅脑损伤后进展性出血性损伤（PHI）的相关危险因素,为其早期诊治和有效预防提供依据.方法 选取湖南省长沙市中医医院神经外科自2007年8月至2009年2月收治的颅脑损伤患者262例（发生PHI 125例,未发生PHI 137例）,多因素Logistic回归分析患者的年龄、性别、出血部位、出血类型、瞳孔情况、入院时收缩压、伤后至首次CT时间、GCS评分、受伤机制、首次CT和第2次CT的间隔时间、大剂量应用甘露醇、血小板计数（PLT）、凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）对PHI发生的影响.结果 单因素分析显示年龄、出血类型、伤后至首次CT时间、GCS评分、PLT、PT、APTT对PHI发生的影响具有统计学意义（P＜0.05）.多因素Logistic回归分析显示伤后至首次CT时间、GCS评分、PLT是PHI发生的独立危险因素,OR值分别为3.5448、3.0975、2.2361.结论 对于首次CT检查时间较早、GCS评分低、PLT较低的中重型颅脑损伤患者,要警惕PHI的发生,及时行正规的动态CT复查,提高PHI的诊断和救治成功率.

Objective To study the risk factors related with progressive hemorrhagic injury （PHI）after severe head injury for a view to early diagnosis and treatment for this disease and providing a basis for effective prevention. Methods In a retrospective study of 262 patients with severe brain injury in considering the clinical data of the PHI, the occurrence is variable, and age, gender, bleeding site, type of bleeding, dilated pupils starus, level of systolic blood pressure on admission, time of CT for the first time,GOS scores, injured mechanism, interval between first and second time CT, application of high-dose mannitol, platelet （PLT） count, prothrombin time （PT）, activated partial prothrombin time （APTT） were considered as independent variables. Results The incidence rate of having PHI was 47.7% （125/262）;single-factor analysis revealed that, as compared with those in patients with non-PHI, 7 factors in patients with PHI were significantly different, namely, age, type of hemorrhage, interval between injury and first-time CT, GCS scores, PLT count, PT and APTT. Multivariate logistic regression analysis of the results showed that interval between injury and first-time CT, GCS scores, PLT count were the risk factors of having PHI, and their OR values were 3.5448, 3.2975 and 2.2361, respectively. Conclusion For patients with severe brain injury, the sooner the first time CT examination is performed, the lower the GCS scores are and the lower the PLT count is, the higher risk of having PHI is. Thus, dynamic CT formal review is suggested to improve the early diagnosis and treatment of PHI.