重型颅脑外伤性脑梗死的发生率及其危险因素分析

The incidence of posttraumatic cerebral infarction and the analysis of its risk factors in patients with severe traumatic brain injury

目的调查重型颅脑外伤性脑梗死的发生率,分析其发生的危险因素。方法回顾性分析208例重型颅脑外伤患者,收集年龄、性别、入院时间、入院时GCS评分、蛛网膜下腔出血、中线移位、环池形态、脑疝、急诊手术、创伤严重程度评分和APACHEⅡ评分等资料,计算重型颅脑外伤性脑梗死的发生率,采用多因素分析确定重型颅脑外伤性脑梗死发生的危险因素。结果 31例(14.9%)重型颅脑外伤患者发生外伤性脑梗死。多因素分析显示,脑疝(OR=6.421,95%CI=2.312～22.517,P=0.001)和GCS评分(OR=0.422,95%CI=0.233～0.851,P=0.002)是重型颅脑外伤并发脑梗死的独立危险因素。结论重型颅脑外伤性脑梗死的发生率较高,伤情和并发脑疝是重型颅脑外伤性脑梗死发生的独立危险因素。

Objective To investigate the incidence of posttranmatic cerebral infarction and analyze its risk factors in patients with severe traumatic brain injury. Methods 208 patients with severe traumatic brain injury were retrospectively reviewed. Age, gender, admission time, Glasgow coma scale score, subarachnoid hemorrhage, midline shift, appearance of cisterna ambiens, brain hernia, emergency operation, injury severity score and APACHE 11 score were abstracted. The incidence of posttraumatic cerebral infarction was calculated. Multivariate analysis was performed using logistic regression to indentify independent risk factors. Results Thirty-one （14.9%） patients had a confirmed posttraumatic cerebral infarction. A multivariate logistic regression identified brain hernia （OR=6.421, 95%CI=2.312-22.517, P=0.001） and Glasgow coma scale score （OR=0.422, 95%CI=0.233-0.851, P=0.002） as independent risk factors of posttraumatic cerebral infarction in patient with severe traumatic brain injury. Con- clusion The incidence of posttraumatie cerebral infarction is high in patients with severe traumatic brain injury. Injury severity and brain hernia are independent risk factors of posttraumatic cerebral infarction in patients with severe traumatic brain injury.