中型颅脑创伤预后的危险因素分析  

Analysis of prognostic risk factors of moderate traumatic brain injury

作　　者：闫志丰 陈明生[1] 葛顺楠 屈延 李志红 YAN Zhifeng;CHEN Mingsheng;GE Shunnan;QU Yan;LI Zhihong(Department of Neurosurgery,Tangdu Hospital,Air Force Medical University,Xi'an 710038,China;Department of Neurosurgery,First Affiliated Hospital of Xi'an Medical University,Xi'an 710077,China)

机构地区：[1]空军军医大学唐都医院神经外科,陕西西安710038 [2]西安医学院第一附属医院神经外科,陕西西安710077

出　　处：《空军军医大学学报》2022年第4期432-435,439,共5页Journal of Air Force Medical University

基　　金：国家自然科学基金(81701310)。

摘　　要：目的研究中型颅脑创伤患者不良预后的危险因素。方法收集入住唐都医院神经外科且被确诊为中型颅脑创伤的连续病例448例,回顾性分析患者入院时的临床表现、化验结果及影像检查结果等资料,二分类logistic回归模型对患者资料进行单因素分析和多因素分析,探寻中型颅脑创伤预后相关的危险因素。结果448例病例中预后良好256例(57.14%),预后不良192例(42.86%)。预后不良组病例中高血压病史(23.44%)和阿司匹林服药史(6.25%)的比例更高(P<0.05)。单因素分析结果提示患者年龄、高血压病史、阿司匹林服药史、入院时格拉斯哥昏迷评分、蛛网膜下腔出血(SAH)、颅骨骨折、硬膜外血肿、硬膜外血肿量、硬膜下血肿、硬膜下血肿部位、硬膜下血肿厚度、脑挫裂伤及其部位和体积、双额挫裂伤、Marshall CT分级、简明损伤评分(AIS)、SAH Fisher分级、纤维蛋白降解产物、纤维蛋白原、D二聚体、肌酐、尿素氮的差异在两组间有统计学意义(P<0.05)。多因素分析结果提示既往高血压病史(P=0.031,OR=2.705)、入院时合并SAH(P=0.000,OR=6.914)、额颞叶挫裂伤体积(P=0.010,OR=1.068)、硬膜外血肿量(P=0.039,OR=1.174)、硬膜下血肿厚度(P=0.010,OR=1.269)、Marshall CT分级(P=0.000,OR=3.165)、AIS(P=0.000,OR=1.227)和D二聚体(P=0.027,OR=1.057)是中型颅脑创伤的独立危险因素。结论既往有高血压病史、入院时CT提示合并SAH、额颞叶挫裂伤、硬膜外血肿、硬膜下血肿、Marshall CT分级高、AIS高和D二聚体值高的中型颅脑创伤患者预后不良、病情恶化的可能性大,应及早发现并及时干预。Objective To explore the risk factors of poor prognosis in patients with moderate traumatic brain injury(TBI).Methods We collected a total of 448 consecutive cases diagnosed with moderate TBI admitted to the Department of Neurosurgery in Tangdu Hospital.Their clinical manifestations,laboratory tests results,and imaging examination data at the time of admission were analyzed retrospectively,and binomial logistic regression model was used for univariate and multivariate analysis of the patients data.Results Among the 448 patients,256 had a good prognosis(57.14%)and 192 had a poor prognosis(42.86%).The proportion of patients with a history of hypertension(23.44%)and aspirin administration(6.25%)was higher in the poor prognosis group(P<0.05).Univariate analysis suggested that age,hypertension,aspirin administration,Glasgow Coma Scale at admission,subarachnoid hemorrhage(SAH),skull fracture,epidural hematoma(EDH),EDH volume,subdural hematoma(SDH),SDH location,thickness of SDH,cerebral contusion and laceration and its location and volume,double frontal contusion and laceration,Marshall CT classification,Abbreviated Injury Scale(AIS),SAH Fisher grading scale,fibrinogen degradation product,fibrinogen,D-dimer,serum creatinine and blood urea nitrogen were correlated with prognosis(P<0.05).Multivariate logistic analysis suggested history of hypertension(P=0.031,OR=2.705),SAH(P=0.000,OR=6.914),the volume of contusion and laceration in frontal temporal lobe(P=0.010,OR=1.068),the volume of EDH(P=0.039,OR=1.174),thickness of SDH(P=0.010,OR=1.269),Marshall CT classification(P=0.000,OR=3.165),AIS(P=0.000,OR=1.227)and D-dimer(P=0.027,OR=1.057)were independent risk factors for moderate TBI.Conclusion The patients with a history of hypertension,SAH,contusion and laceration of frontal temporal lobe,EDH,SDH,high Marshall CT classification,high AIS and high D-dimer at the time of admission have a poor prognosis and a high possibility of disease deterioration,which should be prevented and treated as early as possible.

关 键 词：急性颅脑创伤 中型颅脑创伤 预后不良 

分 类 号：R641[医药卫生—外科学] R605.97[医药卫生—临床医学]