急性中重型颅脑损伤患者继发脑梗死的危险因素分析

Risk factors analysis of acute cerebral infarction secondary to moderate-severe brain injury

目的探讨急性中重型颅脑损伤患者继发脑梗死的危险因素,并依据探讨结果制定相应的预防措施。方法选取我院2012-04-2014-01收治并确诊为急性中重型颅脑损伤的患者298例,根据患者有无继发脑梗死,将其分为观察组与对照组。观察组39例为继发脑梗死患者,对照组259例为无继发脑梗死患者,分析各危险因素对急性中重型颅脑损伤患者继发脑梗死的影响。结果单因素分析,继发脑梗死发生的重要相关危险因素有:年龄、格拉斯哥昏迷评分(GCS)、脑疝、创伤性蛛网膜下腔出血、糖尿病和低血压或休克;性别与颅底骨折不是导致继发脑梗死发生的危险因素;导致继发脑梗死发生的独立危险因素是脑疝和低血压。急性中重型颅脑损伤患者继发脑梗死预后恢复良好11例,轻度残疾8例,重度残疾4例,植物生存2例,死亡13例,病死率33.33%,总有效率为48.72%。结论临床应高度重视急性中重型颅脑损伤患者继发脑梗死的相关危险因素,避免血液高黏状态,控制血压及颅内压,注意呼吸道卫生及顺畅,保持出入量平衡,及时补充血容量,降低继发脑梗死的发生率,提高患者生活质量。

Objective To investigate the risk factors of acute cerebral infarction secondary to moderate‐severe brain injury and take appropriate preventive measures based on the results. Methods 298 cases diagnosed with moderate‐severe brain injury admitted in our hospital from April 2012 to January 2014 were selected and divided into two groups according to whether com‐plicated with cerebral infarction. 39 cases with secondary cerebral infarction were considered as observation group and 259 pa‐tients without secondary cerebral infarction as control group. We analyzed the impact of various risk factors on patients with a‐cute cerebral infarction secondary to severe traumatic brain injury.Results Univariate analysis showed that except for brain hernia and hypotension ,risk factors associated with the occurrence of secondary cerebral infarction included age ,Glasgow Co‐ma Score（GCS） ,brain hernia ,traumatic subarachnoid hemorrhage ,diabetes and low blood pressure or shock ;among which brain hernia and hypotension were independent risk factors. 11 cases were in good prognosis ,8 cases suffered from mild disa‐bility ,4 cases with severe disability ,plants survive occurred in 2 cases ,13 cases died ,mortality was 33.33% and total effec‐tive rate was 48.72%. Conclusion Clinic should attach great importance to risk factors associated with cerebral infarction sec‐ondary to moderate‐severe acute traumatic brain injury ,which can reduce the incidence of secondary cerebral infarction and im‐prove the quality of life through avoiding high blood viscosity state ,controlling blood pressure and intracranial pressure ,keep‐ing respiratory hygiene and expedite ,balancing intake and output ,replenishing blood volume.