轻度颅脑外伤早期病情进展的高危因素分析  

High risks of early deterioration of mild traumatic brain injury

作　　者：马秋峰[1] 张文川[1] 李国伟[1] 钟文翔[1] 杨晓笙[1] 杨敏[1] 廖陈龙[1] 施君[1] 

机构地区：[1]上海交通大学医学院附属新华医院神经外科,上海200092

出　　处：《中华实用诊断与治疗杂志》2014年第5期471-473,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：上海市自然科学基金(10zr1420100)

摘　　要：目的探讨轻度脑外伤早期病情恶化进展的影响因素。方法 413例轻度颅脑外伤患者依据病情是否进展分为病情进展组21例与病情未进展组392例,比较2组一般资料,采用单因素及多因素logistic回归模型分析轻度颅脑外伤患者早期病情进展恶化的影响因素。结果 2组患者性别比例及伤后镇静药使用情况比较差异无统计学意义(P>0.05);非条件单因素logistic回归模型分析显示,年龄≥60岁、一过性意识丧失、中线移位>0.5cm、脑挫裂伤或颅内血肿、GCS评分、神经功能缺失、高血压、使用抗凝药是病情恶化进展的影响因素;多因素logistic回归分析显示,年龄≥60岁、中线移位>0.5cm、脑挫伤或颅内血肿、使用抗凝药是轻度颅脑外伤患者早期病情进展恶化的独立危险因素。结论对年龄≥60岁、中线移位>0.5cm、脑挫伤或颅内血肿、使用抗凝药的颅脑外伤患者进行早期干预,对预防病情进展及改善预后有重要意义。Objective To discuss the main influence factors of early deterioration of mild traumatic brain injury. Methods The clinical data of 413 patients with mild traumatic brain injury were analyzed, including deterioration group （n = 21） and no-deterioration group （n = 392）. The influence factors in two groups by univariate and multivariable logistic regression analysis. Results The gender proportion and the usage of depressant showed no significant differences between two groups （P 〉 0.05）. The unconditional univariate logistic analysis indicated age ≥ 60 years, transient unconsciousness, midline shift 〉0.5 cm, brain contusion or haematoma, GCS score, neurofunction deficit, hypertension and the usage of anti-coagulant drug were the influence factors of deterioration. The multivariable logistic regression analysis indicated age 〉60 years, midline shift 〉0.5 cm, brain contusion or haematoma, and the usage of anti-coagulant drug were independent risks of early deterioration of mild traumatic brain injury. Conclusions Early intervention in the patients older than 60, midline shift 〉0.5 cm, with brain contusion or haematoma and the usage of anti-coagulant drug plays an important role in preventing early deterioration of traumatic brain injury and improving prognosis.

关 键 词：轻度颅脑损伤 恶化进展 高危因素 

分 类 号：R651.15[医药卫生—外科学]