颅脑损伤患者术后迟发性脑水肿的危险因素分析  

Analysis of the risked factors in delayed cerebral edema after traumatic brain injury

作　　者：赵慧 高珊珊 张恬 严婷 Zhao Hui;Gao Shanshan;Zhang Tian;Yan Ting(Department of Neurosurgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]北京首都医科大学附属北京世纪坛医院神经外科,北京100038

出　　处：《海军医学杂志》2022年第3期323-326,共4页Journal of Navy Medicine

基　　金：北京市中医药科技发展基金项目(SYYJ201708)。

摘　　要：目的 探讨颅脑损伤(traumatic brain injury,TBI)术后迟发性水肿的危险因素。方法 回顾性分析2017年1月至2021年1月首都医科大学附属北京世纪坛医院收治的86例TBI患者的临床资料,根据患者脑水肿情况进行分组,其中合并迟发性脑水肿30例为观察组,未合并迟发性脑水肿患者56例为对照组。对比2组基础资料、血肿体积、美国国立卫生研究院卒中表(National Institutes of Health Stroke Scale,NIHSS)评分、血糖浓度及纤维蛋白原(fibrinogen, FIB)水平差异。采用多因素Logistic回归分析探讨TBI术后迟发性水肿的危险因素。结果 单因素分析表明观察组血肿体积、NIHSS评分、血糖浓度以及FIB水平均高于对照组,差异有统计学意义(P<0.05)。2组性别构成、年龄、基础病史、受伤原因以及血肿部位相比,差异无统计学意义(P?0.05)。多因素Logistic回归分析显示,血肿体积、NIHSS评分、血糖以及FIB水平是TBI患者术后迟发性水肿的独立危险因素(P<0.05)。以血肿体积、NIHSS评分、血糖及FIB水平评估迟发性水肿的ROC曲线下面积(AUC)为0.827、0.756、0.715、0.850。结论 TBI患者血肿体积、NIHSS评分、血糖浓度及FIB水平是迟发性水肿的重要危险因素,对评估迟发性脑水肿风险具有一定参考价值。Objective odsThe clinical data of 86 patients with TBI admitted to Beijing Shijitan Hospital from January 2017 to January 2021 were retrospectively analyzed. The patients were divided into two groups according to their illness conditions. 30 patients with delayed cerebral edema were designated as the observation group,while 56 patients without delayed cerebral edema were assigned as the control group. Basic clinical data,hematoma volumes,scores of National Institutes of Health Stroke Scale(NIHSS),blood glucose and fibrinogen(FIB)were compared between the two groups. Univariate analysis and multivariate logistic regression analysis were used to investigate the risk factors of delayed edema after TBI.ResultsUnivariate analysis showed that hematoma volumes,NIHSS scores,blood glucose and FIB levels in the observation group were all higher than those in the control group,with statistical significance(P<0. 05).There were no significant differences in gender,age,basic medical history,causes of injury and hematoma sites,when comparisons were made between the two groups(P>0. 05). Multivariate logistic regression analysis showed that hematoma volumes,NIHSS scores,blood glucose and blood FIB levels were independent risk factors for delayed postoperative edema in the patients with TBI(P<0. 05).The areas under the ROC curve(AUC)for hematoma volumes,NIHSS scores,blood glucose and FIB levels were respectively 0. 827,0. 756,0. 715 and 0. 850.ConclusionHematoma volume,NIHSS scores,blood glucose and FIB levels are important risk factors of delayed cerebral edema in the patients with TBI,which could provide reference for assessing the risk of delayed cerebral edema.

关 键 词：颅脑损伤 迟发性脑水肿 危险因素 纤维蛋白原 

分 类 号：R651[医药卫生—外科学]