颅脑损伤并发进展性出血性损伤的危险因素分析

Analysis of risk factors of progressive hemorrhagic injury in patients with craniocerebral injury

目的：探讨颅脑损伤并发进展性出血性损伤（PHI）的危险因素。方法回顾性分析149例闭合性颅脑损伤患者的临床资料，根据患者是否出现 PHI 分为 PHI 组（42例）及非 PHI 组（107例），全部患者入院即行 CT 检查，非 PHI 患者在首次 CT 后4～8 h 进行常规首次 CT 复查，PHI 组由于临床症状恶化，提前 CT复查。观察两组首次 CT 与复查 CT 时颅内血肿量的变化情况，比较两组患者首次 CT 表现，入院时症状体征及生化指标，分析 PHI 出现的危险因素。结果PHI 组首次 CT、复查 CT 颅内血肿量、两次 CT 颅内血肿增加值明显高于非 PHI 组[（14．59±4．60）mL 比（7．28±2．94）mL，（25．92±8．84）mL 比（8．35±3．41）mL]，（10.20±3．45）mL 比（2．10±0．65）mL]，组间差异均有统计学意义（t ＝6．796、11．894、9．367，均 P ＜0．05）。Logistic 回归分析显示，入院时瞳孔扩大、意识障碍、首次 CT 颅内血肿＞10 mL 为 PHI 的主要危险因素（P ＜0.05）。结论闭合性颅脑损伤患者入院时年龄＞50岁、瞳孔扩大、意识障碍、首次 CT 显示颅内血肿＞10 mL的患者要警惕 PHI 出现。

Objective To discuss the risk factors of progressive hemorrhagic injury（PHI）in patients with craniocerebral injury.Methods Clinical data of 149 patients with closed craniocerebral injury were retrospectively analyzed,and the patients were divided into PHI group （42 cases）and non -PHI group （107 cases）according to PHI appeared or not.The patients were immediately given CT scan after admitted,the first CT review was given in the non -PHI group within routine 4 -8h after first CT scan,and due to deterioration of clinical symptoms,the PHI group was given CT review in advance.The intracranial hematoma volume changes between first CT and first CT review in the two groups were observed,then clinical symptoms,signs,biochemical indicators and CT performance in the two groups were compared,and analyzed risk factors of PHI.Results The intracranial hematoma volume showed in CT scan,first CT review and increment volume of the PHI group were significantly higher than the non -PHI group [（14.59 ±4.60）mL vs.（7.28 ±2.94）mL,（25.92 ±8.84）mL vs.（8.35 ±3.41）mL,（10.20 ±3.45）mL vs. （2.10 ±0.65）mL],the differences were significant （t =6.796,11.894,9.367,all P 〈0.05）.Logistic regression analysis showed that pupil dilation,consciousness disturbance,intracranial hematoma volume 〉10mL were major risk factors of PHI （P 〈0.05）.Conclusion In closed craniocerebral injury,we should pay more attention on PHI if patients with age 〉50 years old,mydriasis,conscious disturbance,intracranial hematoma volume 〉10mL in first CT scan.