颅脑损伤后动、静脉性脑梗死的相关危险因素分析  

Risk factors related to traumatic arterial and venous cerebral infarction after craniocerebral trauma

作　　者：李勇[1] 姜永亮[1] 黄波[1] 

机构地区：[1]上海市松江区中心医院神经外科,201600

出　　处：《中国临床神经外科杂志》2015年第5期284-286,289,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨颅脑损伤继发动脉性脑梗死、静脉性脑梗死的危险因素。方法回顾性分析我院2012年4月～2014年7月收治的169例中、重型颅脑损伤患者的临床资料,采用单因素分析和Logistic回归分析颅脑损伤继发动脉性脑梗死、静脉性脑梗死的可能危险因素。结果单因素分析发现年龄≥60岁、瞳孔散大、中线移位≥10 mm、环池消失、入院时GCS评分≤8分、合并伤以及低血压是动脉性梗死的危险因素（P〈0.05）;而合并伤、大脑浅静脉损伤及D-二聚体增高是静脉性脑梗死的危险因素（P〈0.05）。Logistic回归分析发现,低血压（优势比为3.054;95%可信区间为1.168～3.893;P=0.017）和瞳孔散大（优势比为5.752;95%可信区间为1.035～7.723;P=0.003）是动脉性脑梗死的独立危险因素,大脑浅静脉损伤（优势比为5.827;95%可信区间为1.507～6.384;P=0.002）是静脉性脑梗死的独立危险因素。结论在防治颅脑损伤后动脉性脑梗死或静脉性脑梗死时,脑疝、颅内压、低血压及大脑浅静脉损伤应加强干预。Objective To investigate the risk factors related to the traumatic arterial and venous cerebral infarction after the craniocerebral trauma. Methods The clinical data of 169 patients with middle or severe craniocerebral trauma treated in our hospital from April, 2012 to July, 2014, were analyzed retrospectively. The risk factors related to the arterial and venous cerebral infarction after craniocerebral trauma were analyzed by univariate and multivariate Logistic regression analysis. Results The arterial cerebral infarction occurred in 42 and the venous cerebral infarction occurred in 59 of 169 patients with middle or severe craniocerebral trauma. The univariate analysis showed that the risk factors related to the arterial cerebral infarction included, age t〉 60 years, mydriasis, cerebral midline shift ≥ 10 ram, disappearance of ambient cistern, GCS ≤8 points, associated injuries and hypotension （P〈0.05）, and the factors related to the venous cerebral infarction included associated-injuries, superficial cerebral veins injury and increase in the D-dimer value （P〈0.05）. The multivariate Logistic regression analysis showed that hypotension and mydriasis were the independent risk factors of the arterial cerebral infarction （P〈0.05）, and superficial ＇cerebral veins injury was the independent risk factors of venous cerebral infarction （P〈0.05）. Conclusion Hypotension and mydriasis, which are the independent risk factors of the arterial cerebral infarction, and superficial cerebral veins injury, which is the independent risk factors of venous cerebral infarction, should be positively treated in order to prevent the cerebral infarction after the craniocerebral injury.

关 键 词：颅脑损伤 脑梗死 动脉 静脉 危险因素 

分 类 号：R651.15[医药卫生—外科学]