急性颅脑损伤后进展性出血性损伤高危因素分析  

Evaluation on the related high-risk factors of progressive hemorrhagic injury after acute traumatic brain injury

作　　者：李雪元[1] 马林[1] 王新军[1] 寿记新[1] 

机构地区：[1]郑州大学第五附属医院神经外科一病区,郑州450052

出　　处：《重庆医学》2014年第8期915-917,共3页Chongqing medicine

摘　　要：目的探讨急性颅脑损伤后进展性出血性损伤(PHI)相关的高危因素,为临床判断和预防提供依据。方法回顾性分析该科收治的398例闭合性颅脑损伤住院患者的临床资料,按是否发生PHI分为进展组和非进展组。结果单因素分析显示,患者年龄、性别比、受伤到首次CT时间、入院格拉斯哥昏迷(GCS)评分、平均动脉压、合并颅骨骨折、合并硬膜外血肿、合并脑挫伤、合并蛛网膜下腔出血、双侧伤、意识障碍、瞳孔扩大、首次CT颅内血肿量大于10mL、首次CT血肿量、首次复查CT血肿量、两次CT血肿量差、血小板、血浆纤维蛋白水平、D-二聚体水平、住院总CT数、总住院天数为影响因素(P<0.05)。多因素分析显示,受伤到首次CT时间、GCS<12分、意识障碍、瞳孔扩大、首次CT颅内血肿量大于10mL、合并脑挫伤、合并蛛网膜下腔出血、血小板、D-二聚体水平为PHI的独立危险因素(P<0.05)。结论急性颅脑损伤患者应及时进行头颅CT检查,对GCS<12分、意识障碍、瞳孔扩大、首次CT颅内血肿度大于10mL、合并脑挫伤、合并蛛网膜下腔出血、血小板和D-二聚体水平异常的患者,应密切观察病情进展,尽早定时复查头颅CT。Objective To investigate the related high-risk factors of the occurrence of progressive hemorrhagic injury （PHI） after acute traumatic brain injury ,and to provide the basis for early clinical diagnosis and treatment .Methods Retrospective analysis the clinical data of 398 cases of traumatic brain injury patients .According to whether PHI occurred ,the patients were divided into the progress group and non-progress group .Relevant factors with progressive hemorrhagic injury were assessed .Results The univari-ate analysis showed that ,the age ,gender ratio ,injury to first CT time ,GCS score when admitted in hospital ,mean arterial pressure , combined with skull fracture ,combined with epidural hematoma ,combined with cerebral contusion ,bilateral injury ,subarachnoid hemorrhage ,disturbance of consciousness ,mydriasis ,volume of intracranial hematoma more than 10 mL and volume of hematoma at the first CT scanning ,Platelets ,plasma fibrin concentration and D-dimer influenced the development of progressive hemorrhagic in-jury（P＆lt;0 .05） .Logistic regression showed that ,injury to first CT time ,GSC score less than 12 ,disturbance of consciousness ,my-driasis ,volume of hematoma more than 10 mL at the first CT scanning ,combined with cerebral contusion ,combined with subarach-noid hemorrhage ,platelet and D-dimer were the independent risk factors for PHI （P＆lt;0 .05） .Conclusion Patients with acute brain injury should be promptly head CT .Patients with GCS score less than 12 ,disturbance of consciousness ,mydriasis ,volume of in-tracranial hematoma more than 10 mL at the first CT scanning ,combined with cerebral contusion ,subarachnoid hemorrhage ,platelet and D-dimer were the independent risk factors of the progressive hemorrhagic injury after traumatic brain injury ,Should closely ob-serve the illness progress ,regularly review the head CT as soon as possible .

关 键 词：颅脑损伤 回顾性研究 进展性出血 高危因素 

分 类 号：R651.15[医药卫生—外科学]