外伤性脑损伤患者发生钝性脑血管损伤的危险因素及早期抗凝的研究

Risk factors of blunt cerebrovascular injuries in patients with traumatic brain injury

目的评价并发钝性血管损伤（BCVI）的重度外伤性脑损伤（TBI）患者的疾病特征以及发生BCVI的危险因素与早期抗凝治疗的影响。方法选取2010-07-2016-06在四川省医学科学院四川省人民医院神经外科ICU治疗的TBI患者。根据患者是否发生BCVI，将患者分为BCVI组与非BCVI组。单因素分析两组患者临床变量、BCVl分级、术后6个月和1年预后差异，采用多因素Logistic回归模型分析患者发生BCVI的危险因素，分析BCVI患者的治疗过程及并发症发病情况。结果共纳入505例重症TBI患者，包括52例（10．3％）BCVI患者与453例非BCVI患者，多因素Logistic回归分析显示，重症TBI患者发生BCVI的危险因素为：ISS评分（OR=2．030，95％C11．146-3．598。P=0．021），摩托车碰撞（OR=2．448，95％C11．336～34．387，P=0．004），累及颈动脉骨折（OR=11．633，95％CI1．250～83．965，P=0．009），颈椎损伤（OR=13．591，95％CI3．498—54．879，P=0．001），肺挫伤（OR=7．941，95％CI1．090～53．432，P=0．031），肝损伤（OR=13．657，95％CI2．765～80．379，P=0．007）。在46例幸存者中，有38例（82．6％）患者进行了全身抗凝治疗，全身抗凝开始时间为人院后第（1．52±0．46）天。结论重症TBI患者发生BCVI比较常见，引发重症TBI患者发生BCVI的主要危险因素是患者发生上躯体损伤（累及颈动脉骨折、颈椎损伤、肺挫伤与肝损伤）和摩托车碰撞损伤，对患者进行早期抗凝治疗是安全有效的。

Objective To evaluate the disease characteristics of severe TBI patients complicated with blunt cerebrovascular injuries （BCVI）, the risk factors for BCVI and the effect of early anticoagulant therapy. Methods The patients with severe traumatic brain injury （TBI） treated in our department of neurosurgery were enrolled. The patients were divided into BCVI group and non - BCVI group according to the occurrence of BCVI. Univariate analysis was used to analyze the differences of clinical variables, BVCI grade, postoperative 6 months and 1 year prognosis between the two groups. Multivariate Logistic regression model was used to assess the risk factors of BCVI. The course of treatment and complications of BCVI patients were analyzed. Results 505 patients with severe TBI were enrolled, including 52 （ 10.3% ） BCVI patients and 453 non - BCVI patients. Multivariate Logistic regression analysis showed that risk factors of BCVI in patients with severe TBI ： ISS score （ OR = 2. 030, 95% C1 1. 146 - 3. 598, P = 0. 021 ）, motorcycle collision （ OR = 2. 448, 95% CI 1. 336 - 34. 387, P = 0. 004）, carotid artery involved fractures （ OR = 11. 633, 95% C1 1. 250 - 83. 965, P = O. 009）, cervical injury （ OR = 13. 591, 95% C1 3. 498 - 54. 879, P = 0. 001 ）, pulmonary contusion （ OR = 7. 941, 95% CI 1. 090 - 53. 432, P = 0. 031 ）, liver injury （ OR = 13. 657, 95% CI 2. 765 - 80.379, P = 0. 007 ）. Conclusion BCVI were common in patients with severe TBI. The main risk factors for BCVI in patients with severe traumatic brain injury are upper body injury （involving carotid artery fracture, cervical injury, pulmonary contusion and liver injury） and motorcycle crash injury. Early anticoagulant therapy for patients is safe and effective.