急性外伤性脑挫伤血肿伤后早期进展的危险因素分析

Analysis of risk factors for traumatic intraparenchymal contusion and hematoma progression in the acute post-injury period

目的分析与急性外伤性脑挫伤血肿(IPH)伤后早期进展相关的危险因素。方法收集159例IPH患者的临床资料,针对损伤机制及部位、凝血功能、GCS评分及有无合并其他血肿等因素进行回顾性分析。结果 159例中,5例血肿变小,95例保持不变,59例进展。IPH伤后早期的进展分别与初始挫伤血肿大小、合并蛛网膜下腔出血或硬脑膜下血肿相关(P<0.05)。伤后初始挫伤血肿大小与此后的增加量呈正相关(P<0.05)。结论 IPH进展多数出现在伤后早期。合并有蛛网膜下腔出血或硬脑膜下血肿及较大初始挫伤血肿是IPH患者伤后早期进展的危险因素,应积极予以动态头颅CT复查。

Objective To analyze the risk factors for traumatic intraparenchymal contusion and hematoma（IPH） progression in the acute post-injury period.Methods Data of 159 head trauma patients with IPH were retrospectively analyzed about the mechanism and location of injury,coagulation,GCS score and presence of merging other hematoma.Results Of 159 cases,hematoma shranked in 10 cases,remained unchanged in 95 cases and enlarged in 59 cases between the first and repeat CT scan.IPH progression was independently associated with the initial size of the hemotoma,the presence of subarachnoid hemorrhage or subdural hematoma（P0.05）.The size of initial IPH was proportionately correlated with the amount of subsequent growth（P0.05）.Conclusion The progress in the majority of IPH appears in the acute post-injury period.IPH associated with subarachnoid hemorrhage or subdural hematoma and bigger initial hematoma are the risk factors for IPH,which should be monitored with dynamic head CT scan.