双额叶挫裂伤患者病情恶化的临床及影像学危险因素及手术干预效果分析

The clinical and iconography risk factors for progression after bifrontal contusions and the efficacy of operation intervention

目的探讨双额叶挫裂伤后病情恶化的临床与影像学相关危险因素以及手术干预的效果。方法选择2014年4月-2017年4月于本院就诊的84例双额叶挫裂伤患者,分析病情恶化和病情稳定患者临床和影像学检查的差异,多因素Logistics回归分析引起病情恶化的相关独立危险因素。对病情恶化患者采取手术干预,并比较病情恶化组和病情稳定组患者的预后差异。结果病情恶化组的年龄、多处受伤比例、入院时ICP和D-二聚体水平较高,入院时GCS较低(P<0.05);病情恶化组的挫裂伤体积、中线移位距离和合并双侧血肿、颅骨骨折的比例显著高于病情稳定组(P<0.05)。多因素Logistics回归分析显示,入院时低GCS评分、高ICP,挫裂伤体积、中线移位和合并颅骨骨折是双额叶挫裂伤患者病情恶化的独立危险因素。病情恶化组术后与病情稳定组的1年病死率(8.70%vs.5.26%,P>0.05)和预后不良率(23.68%vs.28.26%,P>0.05)无明显差异。结论入院时低GCS评分、高ICP,挫裂伤体积、中线移位和合并颅骨骨折是双额叶挫裂伤患者病情恶化的独立危险因素;对高危患者进行手术干预,可以改善患者预后。

Objective To observe the clinical and iconography risk factors for progression after bifrontal contusions and the efficacy of operation intervention.Methods From April 2014 to April 2017,84 traumatic brain injury patients with bifrontal contusions were screened,while the clinical and iconography factors were comparatively analyzed.The multiple factor logistic regression analysis was used to observe the risk factors of for progression after bifrontal contusions.Results There were significant differences in age,multiple injury rate,D-dimer,Glasgow Coma scale（GCS）intracranial pressure（ICP）between the stable group and the progressive group.The percentage of contusion volume,midline shift distance,bilateral hematoncus and skull fracture in the progressive group was significantly higher than those in the stable group（P〈0.05）.The multiple factor logistic regression analysis showed that the GCS and ICP on admission,contusion volume,midline shift,skull fracture were the independent risk factors for progression after bifrontal contusions.While there were no obvious differences in the 1-year mortality（8.70% vs.5.26%,P〉0.05）and poor prognosis rate（23.68% vs.28.26%,P〉0.05）between the stable group and the progressive group.Conclusion The GCS and ICP on admission,contusion volume,bilateral hematoncus,skull fracture were independent risk factors for progression after bifrontal contusions.Operation intervention could improve the prognosis in the early stage for patients with risk factors.