重型颅脑损伤后创伤性脑梗死危险因素的logistic分析

Logistic analysis of risk factors of traumatic cerebral infarction after severe craniocerebral injury

目的探讨影响重型颅脑损伤后创伤性脑梗死(traumatic cerebral infarction,TCI)发生的危险因素。方法选择2006年1月至2016年12月在本院就诊的重型颅脑损伤患者363例,根据是否发生TCI分为TCI组和无TCI组,记录两组患者的性别、年龄、致伤原因、GCS评分、血压、血糖、影像学检查结果、治疗方式等,分析两组患者上述因素的差异及各因素与TCI发生的相关性。结果单因素分析显示,年龄、格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分、脑疝形成、低血压、脑干损伤、创伤性蛛网膜下腔出血、中线移位、颅度骨折、血小板数量、纤维蛋白原、D-二聚体、弥散性血管内凝血(disseminated intravascular coagulation,DIC)评分、血浆黏度、脑血管痉挛、应用脱水剂、应用止血药物均可影响TCI的发生(P<0.05),而性别、脑挫裂伤、硬膜下血肿、糖尿病、开颅手术、颅外感染、出入量、吸烟、饮酒对TCI的发生无显著影响(P>0.05)。多因素logistic分析显示,年龄≥50岁、脑疝形成、创伤性蛛网膜下腔出血、DIC评分≥5分、大量应用脱水剂为TCI发生的独立危险因素(P<0.05),GCS评分升高为TCI发生的保护性因素(P<0.05)。结论重型颅脑损伤后TCI的发生受多种因素影响,临床工作中应根据这些危险因素采取针对性的预防措施,以减少TCI的发生及改善预后。

Objective To study the risk factors of traumatic cerebral infarction after severe craniocerebral injury. Method 363 patients with severe craniocerebral injury in our hospital from January 2006 to December 2016 were selected as research object, and the patients were divided into two groups according to whether the occurrence of TCI. The gender, age, cause of injury, GCS score, blood pressure, blood glucose, imaging findings, treatment modalities and other information of patients in two groups were recorded, and the correlation between various factors and occurrence of TCI was analyzed. Result The single factor analysis showed that age, GCS score, cerebral herniation, hypotension, brainstem, traumatic subarachnoid hemorrhage, midline shift, cranial fracture degree, platelet count, fibrinogen, D-dimer, DIC score, plasma viscosity, cerebral vasospasm, dehydrating agent, application of hemostatic drugs could influence the occurrence of TCI （P〈0.05）, and the gender, brain contusion, subdural hematoma, diabetes mellitus, craniotomy, extracranial infection, intake and output, smoking and drinking had no significant effect on TCI （P〉0.05）. The multivariate logistic analysis showed that 50 years of age or older, hernia formation, traumatic subarachnoid hemorrhage, DIC score more than 5 points, a dehydrating agent application were the independent risk factors of TCI （P〈0.05）, and GCS score was a protective factor for the occurrence of TCI （P〈0.05）. Conclusion The occurrence of TCI after severe craniocerebral injury is affected by many factors, clinician should develop targeted preventive measures to reduce the incidence of TCI and improve the prognosis.