重度脑挫裂伤合并颅内血肿伴中央型脑疝手术患者预后生存的影响因素分析

Analysis on influencing factors of prognostic survival in surgical patients with severe cerebral contusion and laceration complicating intracranial hematoma and central cerebral hernia

目的探讨重度脑挫裂伤合并颅内血肿伴中央型脑疝手术患者预后生存的相关影响因素。方法2015-2019年在该院治疗的136例重度脑挫裂伤合并颅内血肿伴中央型脑疝的患者为研究对象。按手术时机,入院<24 h行手术治疗的患者作为A组(57例),入院≥24 h行手术治疗的患者作为B组(79例)。比较两组患者生存率,分析患者预后生存的相关影响因素。结果A组生存率84.21%明显高于B组生存率67.09%(P<0.05)。单因素分析显示,入院时出血量、入院时GCS评分、甘露醇应用时间、重症监护室治疗时间、入院前1周内曾应用抗凝药物、脑挫裂伤部位均为预后生存的影响因素(P<0.05);多因素分析显示,入院时GCS评分<8分(OR=0.124)、多发性脑挫裂伤(OR=0.438)、出血量≥30 mL(OR=0.053)、甘露醇应用时间≥2周(OR=0.136)、重症监护室治疗时间≥1周(OR=0.987)、入院前1周内曾应用抗凝药(OR=0.077)、入院≥24 h手术治疗(OR=0.175)的患者预后更差(P<0.05)。结论临床应对重度脑挫裂伤合并颅内血肿伴脑疝患者尽早开展评估以制订合理的治疗方案,确定合适的手术时机。

Objective To investigate the related influencing factors of prognostic survival in the patients with severe cerebral contusion and laceration complicating intracranial hematoma and central cerebral hernia.Methods One hundred and thirty-six patients with severe cerebral contusion and laceration complicating intracranial hematoma and central cerebral hernia treated in this hospital from January 2015 to December 2019 were enrolled as the study subjects.The patients conducting the surgical treatment within 24 h after admission served as the group A(57 cases),and who conducted the surgical treatment after 24 h served as the group B(79 cases).The survival rates were compared between the two group.The related influencing factors affecting the prognostic survival of the patients were analyzed.Results The survival rate in the group A was 84.21%,which was significantly higher than 67.09%in the group B(P<0.05).The univariate analysis showed that the bleeding volume,GCS score at admission,using mannitol time,ICU stay time,using anticoagulant drugs within 1 week before admission and site of brain contusion and laceration were the influencing factors of prognostic survival(P<0.05);the multivariate analysis showed that the prognosis in the patients with the GCS score<8 points(OR=0.124),multiple brain contusion and laceration(OR=0.438),bleeding volume at admission≥30 mL(OR=0.053),mannitol application time≥2 weeks(OR=0.136),ICU stay time≥1 week(OR=0.987),anticoagulant drugs used in 1 week before admission(OR=0.077)and surgical treatment timing≥24 h(OR=0.175)was worse(P<0.05).Conclusion Clinic should conduct the evaluation on the patients with severe cerebral contusion and laceration complicating intracranial hematoma and central cerebral hernia as early as possible in order to formulate the rational treatment scheme and determine the suitable operation timing.