颅脑损伤开颅术中急性脑膨出患者院内死亡相关因素的 Logistic 回归分析

Analysis of in-hospital death-related factors for acute encephalocele in patients with craniocerebral injury for craniotomy

目的：探讨颅脑损伤开颅术中急性脑膨出患者的院内死亡相关因素，为临床治疗及预后判断提供依据。方法收集105例颅脑损伤开颅术中急性脑膨出患者的临床资料。分析患者性别、年龄、术前格拉斯哥昏迷评分（GCS）、术前颅内压（ICP）、术后瞳孔状态、脑膨出原因、术后 GCS 评分，术后 ICP、凝血机制、脑膨胀情况、术前缺氧、术前血压和血糖等因素与院内死亡的相关性。结果术后根据格拉斯哥预后分级（GOS）评估预后，其中死亡（死亡组）77例，生存（生存组）28例。Logistic 回归分析结果显示，患者术后 GCS评分（Wald ＝14．127，Exp（B）＝0．044，95％CI：[0．032，0．448]）、脑膨出原因（Wald ＝7．748，Exp（B）＝8．183，95％CI：[1．825，10．251]）、术后 ICP（Wald ＝7．637，Exp（B）＝7．637，95％CI：[1．969，8．028]）、术后瞳孔状态（Wald ＝4．001，Exp（B）＝2．499，95％CI：[1．019，5．122]）和血糖（Wald ＝7．915，Exp（B）＝8．891，95％CI：[1．790，9．337]）与颅脑损伤术中急性脑膨出患者的院内死亡密切相关（P ＜0．05）。结论术后 GCS 评分、脑膨出原因、术后 ICP、术后瞳孔状态和血糖可作为预测颅脑损伤开颅术中急性脑膨出的院内死亡的重要指标。积极预防术中脑膨出，及时降低患者颅内压，是有效降低急性脑膨出患者院内死亡的重要措施。

Objective To investigate the in-hospital death-related factors for acute encephalocele in patients with craniocerebral injury for craniotomy in order to provide evidence for clinical treatment and prognosis determina-tion.Methods The clinical data of 105 patients with craniocerebral injury occurring acute encephalocele during cra-niotomy were analyzed retrospectively.The correlations of the factors including sex,age,preoperative Glasgow coma scale（GCS）scores,preoperative intracranial pressure（ICP）,postoperative pupil status,causes of encephalocel,post-operative GCS scores,postoperative ICP,coagulation mechanism,brain swelling,preoperative hypoxia,preoperative blood pressure and blood glucose were analyzed.Results The prognosis was assessed according to the Glasgow out-come scale（GOS）scores after procedure.There were 77 patients in death group（namely death cases）and 28 patients in survival group.Logistic regression analysis showed that postoperative GCS scores （Wald =14.127,Exp（B）=0.044,95%CI：0.032,0.448）,causes of encephalocel（Wald =7.748,Exp（B）=8.183,95%CI：1.825,10.251）, postoperative ICP（Wald =7.637,Exp（B）=7.637,95% CI：1.969,8.028）,postoperative pupil status（Wald =4.001,Exp（B）=2.499,95%CI：1.019,5.122）and blood glucose（Wald =7.915,Exp（B）=8.891,95% CI：1.790,9.337）were closely associated with the in-hospital death in patients with acute encephalocele in craniocere-bral injury operation（P 〈0.05）.Conclusion The postoperative GCS scores,causes of encephalocel,postoperative ICP,postoperative pupil status and blood glucose could be used as the important indexes for predicting in-hospital death of acute encephalocele in craniocerebral injury for craniotomy.To prevent the intraoperative encephalocele and reduce the intracranial pressure are the important measures to reduce the mortality rate of the patients with acute encephalocele.