进展性脑挫裂伤发生的高危因素及预后分析

High risk factors of progressive cerebral contusion and its correlation with prognosis in patients with brain ;contusion and laceration

目的：研究脑挫裂伤患者发生进展性脑挫裂伤的危险因素，分析脑挫裂伤预后的相关性。方法选择脑挫裂伤患者128例，根据24 h 内再次颅脑 CT 检查结果将患者分为进展组（68例）和非进展组（60例）。应用单因素和多因素 Logistic 回归分析分析进展性脑挫裂伤的危险因素，并分析患者预后的相关因素。结果进展组和非进展组患者入院 GCS 评分、损伤部位、脑挫裂伤体积、中线移位、合并颅骨骨折、合并蛛网膜下腔出血、合并硬膜下血肿、合并糖尿病和 D-二聚体水平差异有统计学意义（χ2＝9．336，P ＝0．009；χ2＝18．486，P ＝0．001；t ＝2．889，P ＝0．000；t ＝2．684，P ＝0．015；χ2＝16．164，P ＝0．000；χ2＝10．824，P ＝0.001；χ2＝8．667，P ＝0．003；χ2＝8．667，P ＝0．003；χ2＝10．824，P ＝0．001；t ＝2．842，P ＝0．000）。随访6个月，进展组病死率为11．76％，显著高于非进展组的1．67％（χ2＝4．972，P ＝0．026）。Logistic 回归分析显示，入院 GCS 评分、损伤部位、脑挫裂伤体积、合并蛛网膜下腔出血、合并糖尿病和 D-二聚体水平是脑挫裂伤患者发生进展性脑挫裂伤的危险因素（OR ＝0．128、1．894、0．187、37．324、42．974、1．224，P ＝0．014、0．010、0．028、0.018、0．008、0．042，均 P ＜0．05）。经 Logistic 回归分析显示，入院 GCS 评分、损伤部位、脑挫裂伤体积、合并蛛网膜下腔出血和进展性脑挫裂伤是脑挫裂伤预后的影响因素（OR ＝0．133、1．124、0．208、34．321、41．964， P ＝0．018、0．014、0．025、0．018、0．005，均 P ＜0．05）。结论入院 GCS 评分、损伤部位、脑挫裂伤体积、合并蛛网膜下腔出血、合并糖尿病和 D-二聚体水平是脑挫裂伤患者发生进展性脑挫裂伤的危险因素，入院 GCS 评分、损伤部位、脑挫裂伤体积、合并蛛网膜下腔出血和进展性脑挫裂伤是脑挫裂伤预后的影响因素，临床应予以重视。

Objective To study the risk factors of progressive cerebral contusion and laceration in patients with brain contusion and laceration,and to analyze the correlation between the prognosis of brain contusion and lacera-tion.Methods 128 patients with cerebral contusion and laceration were selected,and the patients were divided into the progress group （68 cases）and the non progress group （60 cases）according to the results of CT examination in 24h.Application of single factor and multiple factor Logistic regression analysis to analyze the risk factors of progres-sive cerebral contusion and laceration.And analyzed the related factors of the prognosis of patients.Results The admission GCS score,site of injury,cerebral contusion and laceration of volume,midline shift,with a skull fracture, complicated with subarachnoid hemorrhage,complicated with subdural hematoma,diabetes mellitus and D dimer level in the progress group and non progress group were significantly different （χ2 =9.336,P =0.009;χ2 =18.486,P =0.001;t =2.889,P =0.000;t =2.684,P =0.015;χ2 =16.164,P =0.000;χ2 =10.824,P =0.001;χ2 =8.667, P =0.003;χ2 =8.667,P =0.003;χ2 =10.824,P =0.001;t =2.842,P =0.000）.Patients were followed up for 6 months,the mortality rate of the progress group was 11.76%,which was significantly higher than 1.67% in the non progress group （χ2 =4.972,P =0.026）.Logistic regression analysis showed that admission GCS score,injury loca-tion,cerebral contusion and laceration of volume,complicated with subarachnoid hemorrhage,diabetes mellitus and D dimer level were risk factors of cerebral contusion and fracture trauma patients occurred in brain contusion and lacera-tion （OR =0.128,1.894,0.187,37.324,42.974,1.224,P =0.014,0.010,0.028,0.018,0.008,0.042,all P 〈0.05）.Logistic regression analysis showed that the GCS score,the site of injury,the volume of brain contusion,the combination of subarachnoid hemorrhage and progressive brain contusion and laceration of brain contusion and lacera-tion were the prognostic factors （OR =0.133,1.124,0.208,34.321,41.964,P =0.018,0.014,0.025,0.018, 0.005,all P 〈0.05 ）.Conclusion Admission GCS score,injury location,cerebral contusion and laceration of volume,complicated with subarachnoid hemorrhage,diabetes mellitus and D dimer level are risk factors of cerebral contusion and laceration happened progressive cerebral contusion and laceration,admission GCS score,site of injury, cerebral contusion and laceration of volume,complicated with subarachnoid hemorrhage and progressive cerebral con-tusion and laceration of brain contusion and laceration of prognostic factors,clinical should pay more attention to it.