创伤性脑损伤后颅内进展性出血危险因素分析  

Analysis of risk factors of intracranial progressive hemorrhage after traumatic brain injury

作　　者：丁军[1] 陈世文[1] 郭衍[1] 王敢[1] 高文伟[1] 曹合利[1] 居世明[1] 陈浩[1] 林在楷[1] 袁方[1] 徐涛[1] 田恒力[1] 

机构地区：[1]上海交通大学第六人民医院神经外科,上海200233

出　　处：《上海交通大学学报（医学版）》2010年第7期829-831,共3页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市科委重点项目(10JC1412500)~~

摘　　要：目的分析创伤性脑损伤患者颅内进展性出血的临床特征及危险因素。方法非手术创伤性脑损伤患者103例,根据颅内出血进展情况分为进展组(n=46)和非进展组(n=57)。比较两组患者的年龄、格拉斯哥昏迷评分(GCS)、受伤至首次CT检查时间(HCT1)、受伤至第二次CT检查时间(HCT2)、入院时凝血功能指标、首次及复查CT血肿量。采用Logistic回归分析颅内进展性出血的危险因素。结果两组患者的年龄、GCS、HCT1、凝血酶原时间(PT)、国际标准化比率(INR)、纤维蛋白降解产物(FDP)、D-二聚体(D-D)、血小板(PLT)计数及复查CT血肿量的差异有统计学意义(P<0.05)。Logistic回归分析显示,年龄、FDP、INR和D-D为颅内进展性出血的危险因素(OR>1,P<0.05);GCS、HCT1和PLT计数值较低的患者发生颅内进展性出血的可能性较大(OR<1,P<0.05)。结论对于创伤性脑损伤患者,年龄、FDP、INR和D-D为颅内进展性出血的危险因素;对GCS、HCT1和PLT计数值较低的患者应加强监护。Objective To analyse the clinical characteristics and risk factors of intracranial progressive hemorrhage after traumatic brain injury. Methods One hundred and three patients who suffered from traumatic brain injury without surgery were divided into progressive hemorrhage group （n=46） and non-progressive hemorrhage group （n=57） according to progression of intracranial hemorrhage. Age, Glasgow coma score （GCS）, hours of first CT scan after injury （HCT1）, hours of second CT scan after injury （HCT2）, parameters of blood coagulation function at admission, hematoma volumes on first and second CT scans were compared between groups. Logistic regression analysis was conducted to analyse the risk factors of intracranial progressive hemorrhage. Results There were significant differences in age, GCS, HCT1, prothrombin time （PT）, international normalized ratio （INR）, fibrin degradation product （FDP）, D-dimmer （D-D）, platelet （PLT） count and hematoma volume on second CT scan between two groups （P〈0.05）. Logistic regression analysis revealed that age, FDP, INR and D-D were risk factors for intracranial progressive hemorrhage （OR〉1, P〈0.05）, and those with lower GCS, HCT1 and PLT count were more prone to intracranial progressive hemorrhage （OR〈1, P〈0.05）. Conclusion For patients with traumatic brain injury, age, FDP, INR and D-D are risk factors for intracranial progressive hemorrhage, and those with lower GCS, HCT1 and PLT count should be managed with intensive care.

关 键 词：创伤性脑损伤 进展性出血 危险因素 

分 类 号：R651.15[医药卫生—外科学]