中重度颅脑损伤继发急性脑梗死相关危险因素分析

Analysis of risk factors associated with acute cerebral infarc-tion in patients with moderate to severe brain injury

目的探讨中重度颅脑损伤患者继发急性脑梗死的相关危险因素.方法将285例中重度颅脑损伤患者根据是否继发急性脑梗死分为观察组(继发急性脑梗死者)34例与对照组(未继发急性脑梗死者)251例.比较两组患者的临床资料,将差异有统计学意义的因素纳入多因素Logistic回归系统中,分析患者继发急性脑梗死的危险因素.比较两组患者入院3个月后的格拉斯哥预后评分.结果285例中重度颅脑损伤患者入院1周内被确诊为急性脑梗死者34例,发生率为13.2%.两组患者年龄、颅脑损伤类型、入院时低血压、入院时高颅内压、入院时格拉斯哥昏迷量表评分、血糖水平、24h尿钠水平、电解质、CT示颅脑损害范围比较差异有统计学意义(P<0.05或0.01).急性脑内血肿和脑挫裂伤、动脉血压≤80mmHg、格拉斯哥昏迷量表评分≤5分、颅内压≥22mmHg、CT示弥漫性脑损伤是中重度颅脑损伤继发脑梗死的危险因素(P<0.05或0.01).观察组患者入院3个月后格拉斯哥预后评分显著低于对照组(P<0.01).结论中重度颅脑损伤继发急性脑梗死发生率较高,预后较差,其相关危险因素与患者病情严重程度直接相关.

Objective To investigate the risk factors associated with acute cerebral infarction in patients with moderate to severe brain injury.Methods 285 patients with moderate or severe craniocerebral injury were divided into observation group (secondary acute cerebral infarction,34 cases) and control group (non secondary acute cerebral infarction,251 cases ) according to w hether they had secondary cerebral infarc-tion.The clinical data of the two groups were compared,and the statistically significant factors were included in the multivariate logistic regression system.Analyze of risk factors for patients with acute cerebral infarction.The GOS of the two groups of patients were co mpared 3 months af ter admission.Results Of the 285 patients with moderate or severe craniocerebral injury,34 patients were diagnosed with acute cerebral infarction within 1 week.The incidence rate was 13.2%.There were significant differences in age,type of brain injury,low blood pressure at admission,high intracranial pressure at admission,Glas-gow Coma Scale score, blood glucose level,24 h urinary sodium level, electroly tes, CT show ed brain damage scope between the two groups (P<0.05 or 0.01).Acute intracerebral hematoma and brain contusion,arterial blood pressure ≤80 mmHg,Glasgow Coma Scale score ≤5,intracranial pressure ≥22 mm-Hg,CT show ed diffuse brain injury were risk factors for moderate and severe craniocerebral injury second-ary cerebral infarction ( P<0.05 or 0.01).The GOS of the observation group patients were significantly lower than those of the control group after 3 months of admission ( P<0.01).Conclusion The incidence of acute cerebral infarction is higher in patients with moderate to severe head injury,and the prognosis is poor.The relevant risk factors are directly related to the severity of the patient's condition.