重型颅脑外伤后发生渗透性脱髓鞘综合症的危险因素分析

Risk Factors of Penetrating Demyelinating Syndrome after Severe Traumatic Brain Injury

目的:分析重型颅脑外伤后发生渗透性脱髓鞘综合症的相关危险因素,为临床预防及治疗提供参考。方法:回顾性分析2011年3月至2016年3月收治的450例中重型颅脑外伤患者的临床资料,根据是否发生渗透性脱髓鞘综合症(ODS)分为ODS组和非ODS组,比较两组患者性别、年龄、入院时损伤程度(GCS评分)、合并伤、脑挫伤、脑疝、颅骨骨折、低血压、创伤性蛛网膜下腔出血、血肿清除、甘露醇使用剂量等指标差异。结果:450例中重型颅脑外伤患者中,发生渗透性脱髓鞘综合症11例,发生率2.44%;单因素分析表明,ODS组年龄大于对照组,重度损伤、合并伤、脑挫伤、脑疝、低血压、血肿清除高于非ODS组(t=9.584,χ~2=4.877~9.584,P<0.05);多因素Logistic回归分析表明,高龄、GCS评分(3~8分)、脑挫伤、低血压、血肿清除为重型颅脑外佃租后发生渗透性脱髓鞘综合症的危险因素(β=0.032~0.754,S.E=0.007~0.302,Wald=5.324~28.302,P<0.05)。结论:重型颅脑外伤后发生渗透性脱髓鞘综合症与年龄、损伤程度、损伤类型等因素有关,应加强对高危因素的预防,减小渗透性脱髓鞘综合症的发生率。

Objective： To analyze the risk factors of penetrating demyelinating syndrome after severe traumatic brain injury,and to provide reference for clinical prevention and treatment. Methods： Retrospective analysis of clinical data from March 2011 to March 2016 in our hospital of 450 cases of severe craniocerebral trauma patients,according to whether the occurrence of osmotic demyelination syndrome（ ODS） were divided into ODS group and non ODS group,compared two groups of patients with gender,age,admission damage degree（ GCS score）,associated injuries,cerebral contusion and the brain,skull fracture,hypotension,traumatic subarachnoid hemorrhage,hematoma,difference of mannitol dosage index. Results： 450 cases of patients with severe traumatic brain injury in the occurrence of osmotic demyelination syndrome in 11 cases,the incidence rate of 2.44%; Single factor analysis showed that the age of the ODS group was significantly higher than the control group,severe injury,injury,hypotension,cerebral hernia,brain contusion,hematoma was significantly higher than non ODS group（ t = 9.584,χ~2= 4.877 ~ 9.584,P〈 0.05）; Multi Logistic regression analysis showed that age,GCS score（ 3-8）,cerebral contusion,hematoma clearance,hypotension for severe brain tallage risk factors after osmotic demyelination syndrome（ β = 0.032 ~ 0.754,S.E = 0.007 ~ 0.302,Wald= 5.324 ~ 28.302,P 〈0.05）. Conclusion： The osmotic demyelination syndrome with age and severity of injury,injury type and other factors related to severe traumatic brain injury,we should strengthen the prevention of risk factors,reduce the incidence of osmotic demyelination syndrome.