脑挫裂伤合并四肢骨折颅内血肿进展的影响因素分析

Analysis of influencing factors on the progression of intracerebral hemorrhage in patients with cerebral contusion and ceration complicated with limb fracture

目的 探讨脑挫裂伤合并四肢骨折患者颅内血肿进展的影响因素。方法 选取2015年3月至2021年5月北京积水潭医院神经外科收治的脑挫裂伤合并四肢骨折患者152例,根据患者在住院期间是否发生颅内血肿进展分为研究组和对照组,收集患者的一般资料和临床资料,并对颅内血肿进展的影响因素进行单因素和多因素logistic回归分析。结果 152例患者中男110例(72.4%),女42例(27.6%);年龄23~88岁,平均(49.2±14.1)岁,发生颅内血肿患者42例(27.6%)。单因素分析显示,两组在性别、住院时间、入院PT、入院APTT、脑挫裂伤范围的比较,差异均有统计学意义(P <0.05)。多因素logistic回归结果显示,住院时间越长(OR=1.403,95%CI:1.210~1.626,P=0.000)、入院PT越高(OR=1.390,95%CI:1.050~1.841,P=0.021)、入院APTT越高(OR=1.183,95%CI:1.040~1.345,P=0.010)的患者,更容易发生颅内血肿进展。结论 住院时间较长、入院PT和APTT较高是脑挫裂伤合并四肢骨折患者颅内血肿进展的危险因素,对具有相关危险因素的患者应积极进行复查和监测。

Objective To explore the influencing factors on the progression of the intracerebral hemorrhage in patients with cerebral contusion and laceration complicated with limb fracture.Methods A total of 152 patients with cerebral contusion and laceration complicated with limb fracture admitted to Neurosurgery Department of Beijing Jishuitan Hospital from March 2015 to May 2021 were selected,and were divided into study group and control group according to whether they had progression of intracerebral hemorrhage or not.The general and clinical data of the two groups were collected and compared.The influencing factors on the progression of intracerebral hemorrhage were analyzed by univariate and multivariate logistic regression.Results Among the 152 patients,110(72.4%)were males and 42(27.6%)were females,aged from 23 to 88 years old,and the average age was(49.2±14.1)years,there were 42 cases(27.6%)with intracerebral hemorrhage.The univariate analysis showed that there were statistically significant differences in gender,length of stay,PT,APTT and scope of brain contusion and laceration between the two groups(P<0.05).Multivariate logistic regression analysis showed that patients with longer hospital length of stay(OR=1.403,95%CI:1.210-1.626,P=0.000),higher PT(OR=1.390,95%CI:1.050-1.841,P=0.021)and higher APTT(OR=1.183,95%CI:1.040-1.345,P=0.010)had a higher risk of progression of intracerebral hemorrhage.Conclusions Longer hospital length of stay,higher PT and higher APTT are the risk factors of progression of intracerebral hemorrhage in patients with cerebral contustion and laceration complicated with limb fracture.Patients with associated risk factors should be actively reviewed and monitored.