中重型颅脑损伤患者继发脑梗死的相关因素分析及护理对策

Related factors of secondary cerebral infarction and nursing in patients with moderate or severe craniocerebral injury

目的探讨中重型颅脑损伤患者继发脑梗死的相关因素并总结护理对策。方法收集585例中重型颅脑损伤患者临床资料，按照是否发生继发脑梗死分为继发脑梗死组和非继发脑梗死组，采用多元Logistic回归分析其危险因素。结果本组患者中发生继发脑梗死57例，占9．74％。单因素分析显示，年龄、GCS评分、脑挫裂伤、合并伤、硬膜下血肿、蛛网膜下腔出血、脑疝及低血压均会影响继发脑梗死的发生及发展（P〈0．05）。多元Logistic回归分析显示，脑疝、低血压及GCS评分低是继发脑梗死发生的独立危险因素。结论临床应高度关注继发脑梗死的各项危险因素，关注高危患者，监测颅内压，采用正确体位，合理的输液方式以及各项护理措施，维持患者脑灌注压，降低继发脑梗死的发生率。

Objective To investigate the related factors of secondary traumatic cerebral infarction （TCI） and nursing in patients with moderate and severe craniocerebral injury. Methods A total of 585 moderate or severe craniocerebral injury patients were divided into TCI group and non TCI group according to whether TCI occurred. The clinical data of two groups was analyzed with multivariate logistic regression to screen the risk factors. Results There were 57 cases in TCI group accounted for 9.74%. Single factor analysis showed that age, GCS scores, brain contusion and laceration, associated injury, subdural hematoma, subarachnoid hemorrhage, cerebral hernia and hypotension would significantly influence the occurrence and development of TCI （P 〈 0.05）. Multivariate logistic regression analysis showed, cerebral hernia, hypotension and low GCS score were independent risk factors of TCI occurrence. Conclusions Close attention should be paid on high-risk patients, intracranial pressure monitoring, correct posture, reasonable infusion method and nursing measures in order to maintain cerebral perfusion pressure and reduce the incidence of TCI.