干预性重型颅脑损伤患者单侧去骨瓣减压术后挫伤性脑出血增大的相关因素及与预后的关系

/ntrusive Severe Craniocerebral Injury Patients with Unilateral to Bone Disc Decompression Surgery Injury Cerebral Hemorrhage/ncreased Related Factors and its Relationship with Prognosis

目的：干预性探讨重型颅脑损伤患者单侧去骨瓣减压术后挫伤性脑出血增大的相关因素及与预后的关系。方法：临床纳入进行单侧去骨辫减压术的重型颅脑损伤患者235例，对患者的性别、年龄、致伤原因、术前情况（GCS评分、瞳孔状态、实验室检查以及头颅CT等）、术后血肿增加量、预后（GOS评分）等指标，观察血肿增大组与血肿未增大组各参数间的临床差异。并进行Rotte，damCT评分与GOS评分的相关性分析。结果：235例患者中，血肿增大组患者120例，血肿未增大组患者115例。纳入影响因素12项，结果显示性别、致伤原因、白细胞计数、C反应蛋白、骨瓣最大径与挫伤性脑出血增大无明显关联，而年龄、首次RotterdamCT评分、GCS评分、瞳孔状态、外伤到开颅时间、血糖值以及疝出幅度等差异存在统计学意义（P〈0．05）。相关性分析显示，RotterdamCT评分与GOS评分存在明显的负相关（P〈0．05）。结论：重型颅脑损伤患者头颅CT的严重程度、血糖水平以及外伤至开颅间隔时间可作为预测单侧去骨瓣减压术后脑挫伤出血增大的风险因素，而RotterdamCT评分综合基底池形态、中线移位程度、蛛网膜下腔出血，根据其水平上升则GOS评分下降这一现象可知RotterdamCT与患者的预后有着较为密切的联系。

Objectiv： Intrusive severe cranioeerebral injury patients with unilateral to bone disc decompression surgery injury cerebral hemorrhage increased related factors and its relationship with prognosis. Methods： 235 patients with severe craniocerebral injury admitted for unilateral deeompressive cranieetomy were selected as clinical cases. The gender, age, the cause of injury, preoperative status （GCS score, pupil status, laboratory examination and CT of head）, the increasing volume of hematoma after the operation, prognosis （ GOS score ） and other indicators of the patients were recorded. The clinical differences among the indicators of the hernatoma enlargement group and the hematoma without enlargement group were observed. The correlation between Rotterdam CT score and GOS score was analyzed. Results： Among the 235 eases, there were 120 cases of patients with hematoma enlargement and 115 patients without enlarged hematoma which was absorbed in the 12 influence factors. The results showed that there was no obvious correlation between the gender, cause of injury, white blood cell count, reaction protein C, maximum diameter of bone flap and the increase of contusive cerebral hemorrhage. The differences of age, first Rotterdam CT score, GCS score, the status of pupils, time from injury to surgery, levels of blood glucose and the amplitude of hernia were significant （ P 〈 0.05 ）. It showed that there was a negative correlation between the Rotterdam CT score and GOS score after the analysis of correlation （ P 〈 0.05 ）. Conclusion： The severity of cranial CT of patients with cranioeerebral injury , levels of blood glucose and the time between injury and craniotomy can be used to predict the risk factors of increased cerebral contusion hemorrhage after unilateral deeompressive craniectomy. According to the phenomenon that while the levels of Rotterdam CT scores integrated with basilar cistern form, the degree of midline shift and subarachnoid hemorrhage rises, the GOS score decreases, it can be found that there is close relationship between Rotterdam CT and the patients＇ prognosis.