双额叶脑挫裂伤病情恶化危险因素及手术干预后疗效分析

Risk factors for deterioration in bifrontal contusions and prognostic analysis of surgical intervention

目的探讨双额叶脑挫裂伤病情恶化临床及影像学危险因素并分析手术干预后患者疗效,为早期临床干预提供指导。方法回顾性分析87例双额叶脑挫裂伤患者临床及影像学资料,根据病情是否恶化并行手术干预分为病情恶化组与病情稳定组,将单因素分析中有统计学意义的危险因素纳入Logistic多因素回归方程,通过逐步法筛选出相关危险因素,最后对患者伤后GOSE评分进行随访。结果 87例双额叶脑挫裂伤患者中病情恶化组21例,病情稳定组66例;Logistic多因素回归分析显示复查头颅CT中双侧侧脑室前夹角>120°(P=0.020)、脑干中脑水平前后径/左右径>1.1(P=0.003)、环池侧翼宽度<0.5 mm(P<0.001)是双额叶脑挫裂伤患者病情进展恶化的独立危险因素;早期恶化组(≤48 h)与迟发恶化组(>48 h)在年龄、入院GCS评分、并发硬膜下血肿上的差异有统计学意义(P<0.05);病情恶化组与病情稳定组伤后GOSE评分差异无统计学意义。结论双额叶脑挫裂伤患者复查头颅CT显示双侧侧脑室前夹角>120°、中脑水平脑干前后径/左右径>1.1、环池侧翼宽度<0.5 mm是保守治疗过程中病情恶化的重要危险因素,筛选出有恶化倾向的病例并早期手术干预可改善患者预后。

Objective To investigate the clinical and radiological factors for deterioration in bifrontal contusions and analysis prognosis of surgical intervention, providing guidance for early clinical intervention. Methods In a retrospective study, the clinical and radiological parameters of 87 patients identified with bifrontal contusions were collected. Patients were divided into deterioration and stable group according to whether progressing deterioration and receiving surgical intervention. The statistically significant risk factors in single factor analysis were incorporated into multivariate logistic regression and selected by stepwise method. Outcomes were evaluated after trauma by using the Glasgow Outcome Scale-Extended （GOSE）. Results Of 87 patients identified with bifrontal contusions,21 had experienced deterioration and 66 had remained stable. Multivariate analysis indicated that the bilateral ventricle anterior angle 〉 120^（ P = 0. 020 ） , the ratio between anteroposterior diameter and transversal diameter of brainstem on the mesencephalon level 〉 1.1 （P =0. 003） ,the width of basal cisterns wing 〈0. 5 mm （P 〈0. 001 ） on follow- up CT were independent risk factors for leading to the occurrence of deterioration. Age, GCS score at admission and subdural hematoma on admission CT were found significant difference between the early（ ≤48 h）and delayed（ 〉 48 h） deterioration group （ P 〈 0.05 ）. Furthermore, there was no significant difference in GOSE score between the deterioration group and the stable group. Conclusion The bilateral ventricle anterior angle 〉 120°, the ratio between anteroposterior diameter and transversal diameter of brainstem on the mesencephalon level 〉 1.1, the width of basal cisterns wing 〈 0. 5 mm on follow-up CT are risk factors for deterioration in patients with bifrontal contusions who initially treated conservatively. Timely detecting deterioration and early surgical intervention are beneficial to prognosis.