创伤性颅脑损伤后发生进展性出血性损伤的危险因素分析

Risk factors of progressive hemorrhagic injury after traumatic brain injury

目的探讨创伤性颅脑损伤(TBI)后发生进展性出血性损伤(PHI)的危险因素。方法回顾性分析409例TBI患者的临床资料,根据有无发生PHI分为PHI组(59例)和无PHI组(350例);采用单因素分析和多因素Logistic回归分析TBI后发生PHI的危险因素。结果本组409例TBI患者中,发生PHI的患者为59例(14.4%)。单因素分析显示,PHI组与无PHI组患者的入院时血糖浓度、GCS评分、血小板计数、活化部分凝血活酶时间、D-二聚体浓度、合并脑挫裂伤或脑实质内血肿、硬膜下血肿、硬膜外血肿、颅骨骨折、蛛网膜下腔出血、中线移位、基底池受压消失的差异有统计学意义(P<0.05~0.001)。多因素Logistic回归分析显示,D-二聚体>3 mg/L(OR=3.02,P=0.017)、合并脑挫裂伤或脑实质内血肿(OR=2.96,P=0.007)、合并硬膜下血肿(OR=2.78,P=0.007)、蛛网膜下腔出血厚度≥5 mm(OR=4.34,P=0.014)、基底池受压消失(OR=5.58,P=0.002)是TBI后发生PHI的独立危险因素。结论对入院时D-二聚体>3 mg/L、合并脑挫裂伤或脑实质内血肿、硬膜下血肿及蛛网膜下腔出血厚度≥5 mm、基底池受压消失的TBI患者要更加警惕PHI的发生。

Objective To investigate the risk factors of progressive hemorrhagic injury(PHI)after traumatic brain injury(TBI).Methods The clinical data of 409 patients with TBI were analyzed retrospectively.According to the occurrence of PHI,they were divided into PHI group(59 cases)and non PHI group(350 cases).Univariate analysis and multivariate Logistic regression were used to analyze the risk factors of PHI after TBI.Results Among 409 TBI patients,59(14.4%)had PHI.Univariate analysis showed that blood glucose concentration at admission,GCS score,platelet count,activated partial thromboplastin time,D-dimer concentration,combined with brain contusion or hematoma in brain parenchyma,subdural hematoma,epidural hematoma,skull fracture,subarachnoid hemorrhage,midline displacement,and basilar cistern compression were associated with PHI(P<0.05-0.001).Multivariate Logistic regression analysis showed that D-dimer>3 mg/L(OR=3.02,P=0.017),cerebral contusion or hematoma(OR=2.96,P=0.007),subdural hematoma(OR=2.78,P=0.007),subarachnoid hemorrhage thickness≥5 mm(OR=4.34,P=0.014)and disappearance of basilar cistern(OR=5.58,P=0.002)were independent risk factors for PHI after TBI.Conclusion More attention should be paid to the occurrence of PHI in TBI patients with D-dimer>3 mg/L,cerebral contusion or hematoma,subdural hematoma and subarachnoid hemorrhage thickness≥5 mm,and disappearance of basal cistern.