颅脑损伤后脑梗塞危险因素的相关性研究

Correlational research of the risk factors of the posttraumatic cerebral infarction

目的：探讨颅脑损伤后创伤性脑梗塞（PTCI）的相关危险因素,并评估预后。方法：回顾分析我院2012-01-2014-01收治的符合条件的592例颅脑损伤患者,其中发生创伤后脑梗塞患者41例,对所有患者的性别、年龄、入院时格拉斯哥昏迷评分（GCS）、脑损伤类型（脑挫裂伤、硬膜外血肿、蛛网膜下腔出血）、脑疝形成、开颅手术、使用止血药物时间、低血压状态、感染等发生PTCI的因素进行单因素分析,并对危险因素进行多因素回归分析,对预后进行对照比较。结果：1592例患者中,41例发生PTCI,发生率为6.93%。2入院时的GCS评分、脑损伤类型、脑疝形成、止血药物应用、低血压状态、感染是PTCI发生的可能危险因素,差异有统计学意义（P〈0.05）;其中入院时的低GCS评分（OR18.023,95%CI5.076~63.992,P〈0.05）、脑挫裂伤（OR43.265,95%CI8.082~231.605,P〈0.05）、脑疝形成（OR14.221,95%CI 2.874~70.374,P〈0.05）及低血压状态（OR5.401,95%CI1.066~27.358,P〈0.05）与PTCI的发生密切相关。3PTCI导致重残（78.05%vs.28.49%）及死亡（9.76%vs.2.36%）的患者均明显高于非PTCI患者（P〈0.05）。结论：入院时低GCS评分、脑挫裂伤、脑疝形成、低血压状态是发生PTCI的高危危险因素,一旦发生PTCI提示预后不良。

Objective：Discussing the risk factors associated with posttraumatic cerebral infarction and assessing the prognosis. Method：Retrospectively analysing of 592 cases of eligible traumatic brain injury patients treated in our department from January 2012 to January 2014,in whom 41 patients suffered PTCI. One-factor analysing the factors of the gender, age,admission GCS score, the type of brain injury （brain contusion, epidural hematoma, sub- arachnoid hemorrhage）, brain herniation, craniotomy, the time of using hemostatic drugs, hypotension, infection as- sociated with PTCI, then multivariate logistic regression analysing the risk factor, and comparing the prognosis. Re- sult：@In 592 patients, 41 cases occurred PTCI, the incidence was 6.93 %. （~） Admission GCS score, the type of brain injury, brain herniation, the time of using hemostatic drugs, hypotension, infection had statistical significance to affect the occurrence of PTCI （P〈0.05） ,and were the suspicious risk factor for PTCI. But low GCS score on admission （OR 18. 023,95%CI 5. 076-63. 992,P〈0.05） ,cerebral contusion （OR 43. 265,95%CI 8. 082-231. 605, P〈0.05） ,brain herniation （OR 14. 221,95%CI 2. 874-70. 374,P〈0.05） ,and hypotension （OR 5. 401,95%CI 1. 066-27. 358,P〈0.05） were closely related to the occurrence of PTCI. （3）The occurrence rate of severe disability （78.05% vs. 28.49G） and mortality （9.76% vs. 2.36%） in PTCI patients were significantly higher than those in non PTCI patients （P〈0.05）. Conclusion： Low GCS score on admission, brain contusion, brain herniation, hypo- tension were high risk factors for PTCI. The happening of PTCI means poor prognosis.