穿透性颅脑火器伤清创术后的预后因素分析

Analysis of prognostic factors for penetrating missile craniocerebral injuries after debridement

目的 分析穿透性颅脑火器伤 (PMCCI)清创术后的预后因素。 方法 回顾性总结分析 16 7例PMCCI清创术后的各项临床资料 ,采用COX比例风险回归模型分析方法和Spearman非参数相关分析方法探讨其预后因素。 结果 16 7例PMCCI术后 2 1例死亡 ,死亡率为 12 .6 %。COX比例风险回归模型分析和Spearman非参数相关分析显示 ,清创时间、特殊类型损伤、压力波损伤及入院格拉斯哥昏迷评分 (GCS)是PMCCI预后的危险因素 (P <0 .0 5 ) ,且分别与出院格拉斯哥预后评分 (GOS)及长期随访GOS各自相关 ;而性别、年龄、穿透伤类型、致伤火器类型、异物留存及颅内感染等均不是危险因素 (P >0 .0 5 ) ,且与长期随访GOS不相关。 结论 清创时间、特殊类型损伤、压力波损伤及入院GCS是PMCCI预后的危险因素 ;颅内感染在PMCCI早期预后中有一定影响 。

Objective To analyze the prognostic factors for the penetrating missile craniocerebral injuries (PMCCI) after debridement. Methods Clinical data of 167 cases of PMCCI were summarized retrospectively and the corresponding prognostic factors explored by COX proportional hazard regression model analysis and Spearman nonparametric correlation analysis. Results After the debridement, 21 cases of PMCCI died with a mortality rate of 12.6%. COX proportional hazard regression model analysis and Spearman nonparametric correlation analysis illustrated that debridement time, special type of PMCCI, pressure wave injury and initial Glascow Coma Scale (GCS) were the independent risk factors for the PMCCI prognosis ( P <0.05), which were correlated with discharging Glascow Outcome Scale (GOS) and with long term follow up of GOS respectively. While gender, age, wound type of PMCCI, missile type, foreign body subsistence and intracranial infection were on the contrary ( P >0.05). Conclusions Debridement time, special type of PMCCI, pressure wave injury and initial GCS are the independent risk factors for the PMCCI prognosis. Intracranial infection may have some effects on the initial evaluation of prognosis, but have no relation to the long-term follow-up evaluation.