重型颅脑外伤患者术中低血压危险因素及预后影响因素分析

Analysis of hypotension danger factors in operation and prognosis affecting factors of patients with severe craniocerebral injury

目的探讨重型颅脑外伤患者发生术中低血压的相关危险因素及对预后的影响。方法回顾性分析148例重型颅脑损伤行开颅治疗患者为研究对象,根据是否发生术中低血压分为观察组(术中出现发生低血压)31例和对照组(未发生术中低血压)117例,观察比较两组患者包括年龄、血肿量、入院GCS、心率、平均动脉压、术中失血量、瞳孔改变、硬膜下血肿发生等相关危险因素Logistic回归分析及观察组中死亡相关危险因素的Logistic回归分析。结果观察组与对照组在术前GCS评分、平均动脉压、血肿量、中位线移位、硬膜下血肿、术中出血情况等方面有显著差异,二元Logistic回归分析可见,GCS评分、中位线移位、平均动脉压及术中出血量有显著性差异(P<0.05),观察组31例患者中死亡8例,死亡患者与存活患者在术前GCS评分、有无瞳孔变化、术中升压等方面有显著差异,二元Logistic回归分析见,GCS评分、术中有无给予升压治疗有显著性差异(P<0.05)。结论术前GCS评分低、中位线移位大、平均动脉压高及术中出血量大是重型颅脑损伤术中发生低血压的危险因素,术前较好的危险评估、术中出血控制、血容量补充及及时的升压治疗能够有效降低重型颅脑损伤患者术中低血压的发生率及死亡率。

Objective To observe and analyze patients with severe craniocerebral injury whose ncidence of intraoperative hypotension and the influence factors on prognosis. Methods Retrospectively analyzed 148 cases of patients with severe craniocerebral injury who were given craniotomy treatment as study objects, based on the occurrence of intraoperative hypotension, they were divided into 31 cases of the observation group(hypotension during operation) and 117 cases of the control group(without the occurrence of hypotension during surgery), age, volume of hematoma, admission GCS, heart rate, mean arterial pressure, intraoperative blood loss, pupil change, subdural hematoma and related risk factors of patients of two groups were observed and analyzed, they were given Logistic regression analysis, and Logistic regression analyzed related risk factors of death of observation group. Results There was a significant difference in the preoperative GCS score, mean arterial pressure, volume of hematoma, the median line shift, subdural hematoma,bleeding and other aspects between the observation group and the control group, GCS score, the median line shift, mean arterial pressure and amount of bleeding had significant difference by binary Logistic regression analysis(P<0.05),31 cases of the observation group had 8 cases died, there were significant differences between the death and survival patients with preoperative GCS score, there were pupillary changes or not, intraoperative blood press increasing etc. Binary Logistic regression analysis, GCS score, operation with or without giving step-up treatment, there was a significant difference(P<0.05). Conclusion Preoperative GCS score low, median line shifts large, mean arterial pressure high and large amount of hemorrhage intraoperative, are risk factors of hypotension occurrence of the operation of severe craniocerebral injury, better assessment preoperative risk, the control of hemorrhage, blood volume replacement and timely blood increasing treatment can effectively reduce the incidence rate and the death rate of hypotension of patients with severe craniocerebral injury.