儿童中重度颅脑损伤后脑血管痉挛的发生、发展以及危险因素的分析

Analysis of the occurrence, development and risk factors of cerebral vasospasm after moderate and severe craniocerebral injury in children

目的分析儿童中重度颅脑损伤后脑血管痉挛的情况以及危险因素。方法对赣州市人民医院2015年3月~2017年3月所收治的儿童中重度颅脑损伤进行回顾性分析,床边TCD检测大脑中动脉血流作为判断脑血管痉挛的方法,分析不同分组脑血管痉挛的情况以及运用Logistic回归分析统计伤后脑血管痉挛的危险因素。结果 76例患儿纳入研究,GCS评分低、出血量多患者平均Vm MCA显著增高。对脑血管痉挛危险因素进行多因素非条件Logistic回归分析,发现入院时GCS评分,有无复合伤,有无合并脑疝是儿童中重度颅脑损伤后脑血管痉挛的独立危险因素。结论儿童中重度颅脑损伤后GCS评分,颅内大量出血患者脑血管痉挛程度重;儿童伤后低GCS评分、脑疝以及复合伤是引起血管痉挛的独立危险因素,应及时进行干预降低风险。

Objective To analyze the situation and risk factors of cerebral vasospasm after moderate and severe craniocerebral injury in children.Methods Children with severe cranioce rebral injury were retrospectively analyzed who were treated in Ganzhou People's Hospital from March2015to March2017.The blood flow of middle cerebral artery by a bedside TCD detection method to determine cerebral vasospasm was used to analysis different groups of cerebral vasospasm,than the Logistic regression analysis of risk factors was performed to analysis the risk factors of cerebral vascular spasm after injury statistics.Results76children were enrolled in the study.The average VmMCA of patients with low GCS score and large amount of bleeding was increased significantly.The risk factors of cerebral vasospasm by multi factor non conditional Logistic regression analysis found that the The GCS score at admission,whether exist combined injury,whether combined hernia were the independent risk factors of cerebral vasospasm after moderate and severe craniocerebral injury in children.Conclusion The degree of cerebral vasospasm is severe in children with moderate and severe craniocerebral injury that have lower GCS score and massive intracranial low GCS score,cerebral hernia and combined injury is the independent risk factors of vascular spasm that should be intervened in time to reduce risk.