颅脑损伤开颅术中急性脑膨出患者院内死亡相关危险因素分析

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

目的研究颅脑损伤开颅术中急性脑膨出患者院内死亡的相关危险因素。方法选择2012年1月至2016年6月行开颅手术并发生急性脑膨出的颅脑损伤患者62例,记录患者的年龄、性别等一般资料,收集术前和术后格拉斯哥昏迷评分(GCS)、术前和术后颅内压(ICP)、术前血糖、术前凝血功能、术后瞳孔变化、是否再次手术、术后并发症及脑膨出原因等数据,采用单因素和多因素logistic回归对院内死亡的危险因素进行分析。结果 62例急性脑膨出患者术后死亡45例,院内死亡率为72.6%。单因素logistic回归分析,开颅手术中急性脑膨出患者院内死亡与存活患者在年龄、受伤至手术时间、术前和术后GCS评分、术前和术后ICP、术前血糖、术前凝血功能、术后瞳孔变化、术后并发症及脑膨出原因等11个相关因素差异有统计学意义(P<0.05);多因素非条件logistic回归分析显示,年龄、术前血糖、术后GCS评分、术后瞳孔变化及脑膨出原因均是急性脑膨出患者院内死亡的独立危险因素(P<0.05)。结论颅脑损伤开颅术中急性脑膨出患者的病死率较高。根据脑膨出原因,结合术后GCS评分确定治疗措施,积极控制血糖,有助于降低院内死亡率。

Objective To explore the in-hospital death-related risk factors for acute encephalocele during craniotomy in patients with craniocerebral injury. Methods The basic data as age,gender etc were recorded,and preoperative and postoperative Glasgow coma scale（ GCS）scores,preoperative and postoperative intracranial pressure（ ICP）,preoperative blood glucose,preoperative coagulation function,pupil change,postoperative and reoperative complications and reasons for encephalocele were collected and treated with univariate analysis and multivariate logistic analysis to assess the risk factors of in-hospital death in patients with acute encephalocele. Results 45 patients died after craniotomy in hospitalization,and the in-hospital mortality was 72. 6%. Univariate analysis showed that there was significant difference in age,time interval from injury,preoperative and postoperative ICP,preoperative GCS scores,preoperative and postoperative blood levels of glucose,preoperative coagulation function,pupil changes,postoperative complications and reasons for encephalocele between survival and dead patients（ P〈0.05）. Multivariate logistic regression analysis showed that age,preoperative blood glucose,preoperative GCS scores,postoperative pupil changes and reasons for encephalocele were independent risk factors for in-hospital death of patients with acute encephalocele druing craniotomy. Conclusion The mortality of acute encephalocele in craniotomy in patients with craniocerebral injury is high. The therapeutic measures for cerebral injury can be made according to the reasons of encephalocele combined with postoperative GCS scores and effectively control of blood glucose can be beneficial in reducing its in-hospital mortality.