重型颅脑损伤去骨瓣减压术预后分析

Prognostic analysis of patients with severe traumatic brain injury treated with decompressive craniotomy

目的分析重型颅脑损伤患者行去骨瓣减压术预后的相关因素。方法对我院于2009年1月-2013年6月收治的110例行单侧或双侧去骨瓣减压术的重型颅脑损伤患者的临床资料进行回顾性分析,其中男性83例,女性27例;年龄14-82岁,平均47.2岁。重点观察年龄、受伤至开颅手术时间、格拉斯哥昏迷评分（GCS）、瞳孔大小、对光的反射程度以及CT检查等相关因素与预后之间的关系,并将患者6个月以内的扩展的Glasgow预后量表以评分的形式对预后进行评价。结果据单因素法分析结果表明,预后良好组及预后不良组在年龄[（139.08±14.45）岁vs.（53.91±14.65）岁]、受伤至开颅手术时间[（35.64±47.71）h vs.（9.55±12.19）h]、瞳孔大小[（12.85±0.49）mm vs.（3.57±1.01）mm]、GCS评分[6.37±1.56vs.4.55±1.08]及CT值[3.55±0.89 vs.4.48±0.96]方面存在明显差异（P〈0.05）,具统计学意义;据多因素Logistic回归法分析结果表明,年龄、受伤至开颅手术时间、瞳孔大小、GCS评分及CT值与预后之间有密切联系。结论患者年龄、受伤至开颅手术时间、GCS评分、瞳孔大小、对光的反射程度以及CT检查等相关因素与预后之间存在密切联系,可作为对重型颅脑损伤患者预后进行评价的临床指标。

Objective To analyze related prognostic factors of patients with severe brain injury performed with decompressive craniotomy. Methods Clinical data of 110 patients（ 83 males and 27 females ranged from 14 to 82 years） with severe traumatic brain injury performed with unilateral or bilateral decompress craniotomy in our hospital from Jan. 2009 to Jun. 2013 were retrospectively analyzed. Relationship between prognosis and such factors as age,time interval from injury to surgery,Glasgow Coma Scale（ GCS）,pupil size,light reflex and CT inspection were analyzed. Extended Glasgow Outcome Scale of patients within six months was employed for prognostic evaluation. Results Analysis results showed that the differences of age,time interval from injury to surgery,GCS,pupil size,light reflex and CT inspection had statistical significance（ P〈0. 05）. Multivariate logistic regression analysis showed that age,time interval from injury to surgery,GCS,pupil size,light reflex and CT inspection were closely related with prognosis. Conclusion Age,time interval from injury to surgery,GCS,pupil size,light reflex and CT are closely related with prognosis of patients with severe brain injury and may be helpful as indicators for their prognostic evaluation.