创伤性大面积脑梗死的相关危险因素分析

Study on the risk factors of large area traumatic cerebral infarction

目的探讨创伤性大面积脑梗死的发生机制及相关危险因素。方法选取自2012年1月至2014年6月期间因颅脑损伤入住深圳市第二人民医院神经外科113例符合条件的重型颅脑损伤病例,根据其头颅CT检查结果是否发生创伤性脑梗死(PTCI),分为PTCI组及非PTCI组,先进行单因素分析创伤性大面积脑梗死的相危害因素,再通过多因素Logistic进行分析,对外创伤性大面积脑梗死的相危害因素进行全面分析,所得数据经统计学分析差异。结果经单因素分析显示,两组低格拉斯哥昏迷指数(GCS)、术前脑疝、术前低血压、术前凝血功能异常、外伤性蛛网膜下腔出血、伤后止血药的应用6个危险因素在两组间进行差异比较均有统计学意义(P<0.05);经Logistic多因素分析显示低GCS、术前脑疝、术前低血压、伤后止血药的应用为外创伤性大面积脑梗死发生的可能危险因素(P<0.05)。结论低GCS、术前脑疝、术前低血压、术前凝血功能异常、外伤性蛛网膜下腔出血、伤后止血药的应用是PTCI的重要危险因素,低GCS、术前脑疝、术前低血压、伤后止血药的应用是创伤性大面积脑梗死的独立危险因素,对这些危险因素进行合理评估,对科学预防与治疗创伤性脑梗死有重要的临床意义。

Objective To investigate the mechanism and related risk factors for massive infarction in patients with severe traumatic brain injury. Methods Retrospectively reviewed the clinical data of the 113 paients with severe traumatic brain injury in department of neurosurgery,Shenzhen second people＇s hospital from January 2012 to June 2014, from which the qualified cases of severe craniocerebral injury were selected, and then divided into PTCI group and non PTCI group according to the head CT examination results whether the occurrence of PTCI. The risk factors were evaluated by univariate and multivariate study, SPSS 19.0 statistical software was applicated for analyzing, univariate analysis by Chi-square examination, multivariate analysis by Logistic regression.Results By univariate analysis, the differences of these six risk factors, Low GCS scores, cerebral hernia, hypotension, Preoperative coagulation dysfunction,subarachnoid hemorrhage, the application of hemostatic agents after injury, between the two groups was statistically significant（ P〈0.05）, they were important risk factors for PTCI. By multivariate logistic analysis, Low GCS scores, cerebral hernia,hypotension, the application of hemostatic agents after injury were the independent risk factors for PTCI.Conclusions Low GCS scores, cerebral hernia, hypotension, Preoperative coagulation dysfunction,subarachnoid hemorrhage, the application of hemostatic agents after injury are the important risk factors of PTCI, Low GCS scores, cerebral hernia, hypotension, Preoperative coagulation dysfunction,subarachnoid hemorrhage, the application of hemostatic agents after injury are the independent risk factors for PTCI. It has important clinical significance for the prevention and treatment of PTCI to focus on these risk factors assessment and reasonable intervention.