中重型颅脑损伤继发脑梗死的危险因素及踝肱指数对预后的影响分析

Analysis of risk factors of cerebral infarction secondary to severe traumatic brain injury and the effect of ankle brachial index

目的分析中重型颅脑损伤继发脑梗死的危险因素,并探讨踝肱指数(ankle brachial index,ABI)对患者预后的影响。方法选取本院2013年7月至2016年7月收治的471例中重型颅脑损伤患者为研究对象。将发生脑梗死患者纳入脑梗死组,将未发生脑梗死者纳入无脑梗死组。计算患者脑梗死发生率,比较两组患者年龄、性别、血肿类型、ABI等基线资料的差异,将存在统计学差异的因素纳入多因素Logistic回归分析,探讨影响患者继发脑梗死的危险因素。采用Pearson相关性分析探讨ABI与继发脑梗死患者出院6个月后格拉斯哥预后量表(Glasgow outcome scale,GOS)评分的相关性,探讨ABI对患者预后的影响。结果 471例患者中,共有74例发生外伤性脑梗死,发生率为15.71%。多因素分析显示,格拉斯哥昏迷评分3~5分、ABI≤0.9、蛛网膜下腔出血、颅底骨折、硬膜下血肿或脑内血肿、脑疝、低血压休克、去骨瓣减压术是导致中重型颅脑损伤继发脑梗死的独立危险因素(P<0.05)。Pearson相关性分析显示,患者基线ABI与其出院后6个月GOS评分呈正相关(r=0.714,P<0.05)。结论中重型颅脑损伤继发脑梗死的危险因素与病情、血肿类型、并发症、治疗方式均具有一定相关性,且ABI可用于早期评估继发脑梗死患者的预后。

Objective To analyze the risk factors of cerebral infarction in patients with severe craniocerebral injury, and to explore the effect of ankle brachial index（ABI） on the prognosis of patients with cerebral infarction. Method 471 patients with severe craniocerebral injury treated in our hospital from July 2013 to to July 2016 were selected as the subjects. Cerebral infarction patients were included in cerebral infarction group, without the occurrence of cerebral infarction were included in non-cerebral infarction group. Calculated the incidence of cerebral infarction patients, the clinical data of two groups were compared between age, severity and type of hematoma and ABI at baseline, there will be significant factors into Logistic regression analysis, summarized the influence of risk factors of cerebral infarction in patients with secondary. Pearson correlation analysis was used to evaluate the correlation between ABI and Glasgow outcome scale（GOS） prognosis of patients with cerebral infarction after 6 months, and to explore the effect of ABI on prognosis. Result 471 cases of patients with traumatic cerebral infarction in a total of 74 cases, the incidence was 15.71%. Multivariate analysis showed that Glasgow coma score 3 ~ 5 points, ABI ≤ 0.9, subarachnoid hemorrhage, skull fracture, subdural hematoma or intracerebral hematoma, cerebral hernia, hypotension, decompressive craniectomy were the result of independent risk factors in cerebral infarction secondary to severe traumatic brain injury（P〈0.05）. Pearson correlation analysis showed that baseline ABI was positively correlated with GOS score 6 months after discharge（r = 0.714, P〈0.05）. Conclusion The risk factors of cerebral infarction secondary to severe traumatic brain injury and disease factors, hematoma type, complications, treatment methods have certain relevance, and ABI can be used to predict the prognosis of patients with cerebral infarction early secondary quality, accordingly the implementation is expected to improve the prognosis of patients with quality of diagnosis and treatment.