亚高原地区颅脑创伤继发性脑梗死的影响因素分析  

Analysis of influencing factors of secondary cerebral infarction caused by craniocerebral trauma in the sub-plateau area

作　　者：童燕翔 林驰 汤进伟 陈晓鹏 Tong Yanxiang;Lin Chi;Tang Jinwei;Chen Xiaopeng(Department of Neurosurgery,the First People's Hospital of Honghe County,Mengzi 661199,China)

机构地区：[1]红河州第一人民医院神经外科,云南省蒙自市661199

出　　处：《中华神经外科杂志》2021年第2期186-189,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨亚高原地区颅脑创伤继发性脑梗死的影响因素。方法回顾性分析2013年9月至2018年2月红河州第一人民医院神经外科收治的260例颅脑创伤患者的临床资料。依据患者的头颅CT或MRI检查结果诊断脑梗死。出院和门诊随访时,采用格拉斯哥预后评级(G0S)评估脑梗死患者的预后,其中Ⅳ~Ⅴ级为预后良好,Ⅰ~Ⅲ级为预后不良。采用单因素和多因素logistic回归分析判断颅脑创伤继发性脑梗死的影响因素。结果260例患者中,继发性脑梗死13例(5.0%),包括大面积脑梗死7例(2.7%)。13例继发性脑梗死的患者中,出院时G0S评级Ⅴ级3例,Ⅳ级1例,Ⅲ级5例,Ⅰ级(死亡)4例。9例患者的随访时间为6~12个月;至末次随访,6例为预后良好,3例为预后不良。单因素分析结果显示,入院时合并脑疝、昏迷及手术治疗是亚高原地区颅脑创伤继发性脑梗死的影响因素(均P<0.05),而性别、年龄、致伤原因、颅脑损伤情况、入院合并基础疾病、颅内感染、血红蛋白(Hb)≥160 g/L,以及Hb<110 g/L等因素均非继发性脑梗死的影响因素(均P>0.05);多因素logistic回归分析结果显示,入院时昏迷是继发性脑梗死的危险因素(OR=4.818,95%CI:1.225~18.954,P=0.024)。结论入院时昏迷的亚高原地区颅脑创伤患者继发脑梗死的风险增加。Objective To explore the influencing factors of secondary cerebral infarction of craniocerebral trauma in the sub-platean area.Methods A retrospective analysis was conducted on the clinical data of 260 patients wth craniocerebral trauma admitted to Department of Neurosurgery,the First Peopled Hospital of Honghe County from September 2013 to February 2018.The cerebral infarction was diagnosed based on the patient's head CT or MRI results.At discharge and outpatient follow-up,the Glasgow Outcome Scale(GOS)was used for outcome assessment:grade Ⅳ-Ⅴ for good outcomes and grade Ⅰ-Ⅲ for poor outcomes.Univariate and multivariate logistic regression analysis were used to determine the influencing factors of secondary cerebral infarction caused by craniocerebral trauma.Results Among 260 patients,there were 13 cases(5.0%)of secondary cerebral infarction including 7 cases(2.7%)of large-area cerebral infarction.At discharge from hospital,the assessment results based on GOS for 13 cases of secondary cerebral infarction were grade Ⅴ in 3 cases,grade Ⅳ in 1 case,grade Ⅲ in 5 case and grade Ⅰ in 4 cases.The follow-up duration of 9 patients was 6-12 months.At follow-up,6 cases had good outcomes and 3 had poor outcomes.The results of univariate analysis showed that brain herniation,coma and surgical treatment at admission were the influencing factors of secondary cerebral infarction of craniocerebral trauma in the sub-plateau area(all P<0.05).There were no statistically significant differences in factors such as gender,age,cause of injury,craniocerebral trauma,comorbid underlying diseases at admission,intracranial infection,hemoglobin(Hb)≥160 g/L or Hb<110 g/L at admission(all P>0.05);multivariate logistic regression analysis showed that coma at admission was a risk factor for secondary cerebral infarction(OR=4.818,95%CI:1.225-18.954,P=0.024).Conclusion Patients with craniocerebral trauma in the sub-plateau area who are comatose at admission have an Increased risk of secondary cerebral infarction.

关 键 词：颅脑损伤 脑梗塞 危险因素 亚高原地区 

分 类 号：R651.15[医药卫生—外科学] R743.33[医药卫生—临床医学]