外伤性大面积脑梗死危险因素分析及改良去骨瓣减压术治疗效果

The risk factors for massive cerebral infarction secondary to traumatic brain injury and the outcomes of modified decompressive craniectomy

目的分析外伤性大面积脑梗死的高危风险因素,总结改良去骨瓣减压术的治疗效果。方法回顾性分析外伤性大面积脑梗死患者47例资料(脑梗组)。其中,手术治疗42例(传统术式15例,改良术式27例)。同期未合并大面积脑梗死手术治疗患者73例作为对照组。单因素分析可能危险因素,再行多因素Logistic回归分析。结果单因素分析显示,两组年龄、术前脑疝、术前高血压、伤后止血药应用和术前凝血功能异常的差异均有统计学意义(P<0.05);Logistic多因素分析显示,年龄、术前脑疝、术前高血压、伤后止血药应用为外伤性大面积脑梗死发生的独立危险因素(P<0.05)。改良去骨瓣减压术较传统术式术后3个月及6个月存活患者神经功能(BI指数)显著改善(P<0.05)。结论临床上需重点关注老年患者的病情变化,并注意控制血压及止血药的应用,及时处理脑疝。改良术式可以有效改善存活患者的预后。

Objective To explore the risk factors for post-traumatic massive cerebral infarction （MCI） in patients with head injury and summarize the effect of modified decompressive craniectomy. Methods Data of 47 cases with post-traumatic MCI（group A） and 73 cases with traumatic brain injury but without MCI（group B） were reviewed. The risk factors for MCI were analyzed. Results The differences in age, brain herniation, hypertension, use of hemostatic drugs, and coagulative disorders were significant between two groups（P^0. 05）. Logistic analysis revealed that the age, brain herniation, hypertension, and use of hemostatic drugs were independent risk factors for the occurrence of MCI in the patients with head injury. The recovery of neurological function in the patients survived in 3 and 6 months after surgery was better in the cases received modified decompressive craniectomy than that in those did conventional surgery（P^0. 05）. Conclusion To reduce the incidence of MCI, much attention should be paid to controlling brain herniation,hypertension, and the use of hemostatic drugs in the patients with head injury. A modified decompressive craniectomy is better than conventional surgery in improving the prognosis of patients survived.