重型颅脑损伤标准去骨瓣减压术后30d内死亡的危险因素分析

Risk factors for death of patients with severe traumatic brain injury within 30 days after standard decompressive craniectomy

目的探讨重型颅脑损伤标准去骨瓣减压术后30 d内死亡的危险因素。方法回顾性分析2016年9月至2019年9月采用标准去骨瓣减压术治疗的145例重型颅脑损伤的临床资料。采用多因素logistic回归分析检验术后30 d内死亡的危险因素。结果145例中,术后30 d内死亡43例,存活102例。多因素logistic回归分析结果显示,入院时GCS评分≤5分、入院时损伤严重度评分≥30分、术前双侧瞳孔散大、合并蛛网膜下腔出血、术前CT显示基底池完全消失及术中低血压为术后30 d内死亡的独立危险因素(P<0.05)。结论对于重型颅脑损伤,入院时GCS低、损伤严重度评分高、双侧瞳孔散大、合并蛛网膜下腔出血、CT显示基底池完全消失且术中低血压的病人,死亡风险较高,手术治疗对改善预后效果不佳。

Objective To investigate the risk factors for the death of patients with severe traumatic brain injury(sTBI)within 30 days after standard decompressive craniectomy(SDC).Methods The clinical data of 145 patients with sTBI who underwent SDC from September 2016 to September 2019 were retrospectively analyzed.Multivariate logistic regression analysis was used to analyze the risk factors for death within 30 days after SDC.Results Of the 145 patients,43 died and 102 survived within 30 days after SDC.Multivariate logistic regression analysis showed that GCS score at admission≤5 points,preoperative injury severity scale score≥30 points,preoperative dilation of bilateral pupils,association of subarachnoid hemorrhage,disappearence of basal cistern on CT and inreoperative hypotension were independent risk factors for the death of patients with sTBI within 30 days after SDC(P<0.05).Conclusions The risk of death is very high in the patients with sTBI who have low GCS score at admission,high score of injury severity scale,bilateral pupil dilatation,subarachnoid hemorrhage,complete disappearence of basal cistern and intraoperative hypotension.Surgical treatment is not effective in improving the patients'prognoses.