颅脑损伤患者并发创伤性脑梗死临床特点及危险因素分析  

Clinical features and risk factors analysis of traumatic cerebral infarction in patients with craniocerebral trauma

作　　者：赵晗 朱奕雄 李钢 Zhao Han;Zhu Yixiong;Li Gang(Department of Emergency,Sanya Central Hospital,Sanya 572000,China;Department of Infection,Lingshui County People′s Hospital of Hainan Province,Sanya 572400,China;Department of Neurosurgery,Sanya Central Hospital,Sanya 572000,China)

机构地区：[1]三亚中心医院急诊科,三亚572000 [2]海南省陵水县人民医院感染科,三亚572400 [3]三亚中心医院神经外科,三亚572000

出　　处：《中国医师进修杂志》2024年第2期112-116,共5页Chinese Journal of Postgraduates of Medicine

基　　金：海南省医药卫生科研项目(1901320272A2006)。

摘　　要：目的探讨颅脑损伤合并创伤性脑梗死(PTCI)的相关危险因素、临床特点及预后情况。方法回顾性选择2021年1月至2023年1月三亚中心医院收治的颅脑损伤患者,其中48例合并PTCI(观察组),132例不合并PTCI(对照组),收集两组临床资料及随访资料,分析颅脑损伤合并PTCI的相关危险因素、临床特点及预后情况。结果单因素分析结果显示,两组患者年龄、性别构成、颅骨骨折、创伤性蛛网膜下隙出血、合并多发伤比较差异无统计学意义(P>0.05);两组中线移位、脑疝、弥漫性脑肿胀、去骨瓣减压、失血性休克、入院Rotterdam CT评分>3分比较差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,脑疝、弥漫性脑肿胀、失血性休克是PTCI发生的危险因素(P<0.05)。Rotterdam CT评分分值越高,患者PTCI的发生率越高。观察组预后良好11例,预后不良37例,格拉斯哥预后量表(GOS)评分(2.45±1.22)分;对照组预后良好74例,预后不良48例,GOS评分(3.69±1.10)分;两组预后情况比较差异有统计学意义(P<0.05)。结论脑疝、弥漫性脑肿胀、失血性休克是颅脑损伤患者合并PTCI的危险因素,并发PTCI的患者预后更差。Objective To explore the risk factors,clinical features and prognosis of traumatic cerebral infarction in patients with craniocerebral trauma.Methods The clinical data and follow-up data of 48 patients with craniocerebral trauma and traumatic cerebral infarction(observation group)and 132 patients with craniocerebral trauma without traumatic cerebral infarction(control group)admitted to the Sanya Central Hospital from January 2021 to January 2023 were retrospectively reviewed.Statistically significant risk factors were screened out by univariate analysis and Logistic regression analysis.Results The results of univariate analysis showed that there were no significant differences in age,sex,skull fracture,traumatic subarachnoid hemorrhage and multiple injuries between the two groups(P>0.05).There were statistical differences in midline displacement,herniation,diffuse brain swelling,decompression of the deboned flap,hemorrhagic shock,and admission Rotterdam CT score>3(P<0.05).The results of multivariate Logistic regression analysis showed that cerebral herniation,diffuse brain swelling and hemorrhagic shock were risk factors for traumatic cerebral infarction(P<0.05).The higher the Rotterdam CT score,the higher the incidence of traumatic cerebral infarction.In the observation group,11 cases had good prognosis and 37 cases had poor prognosis,with an average Glasgow Prognostic Scale(GOS)of(2.45±1.22)points.In the control group,74 cases had good prognosis and 48 cases had poor prognosis,with an average GOS of(3.69±1.10)points.The difference in prognosis between the two groups was statistically significant(P<0.05).Conclusions Cerebral herniation,diffuse cerebral swelling and hemorrhagic shock are risk factors for traumatic cerebral infarction in patients with craniocerebral trauma,and the prognosis of patients complicated by traumatic cerebral infarction is worse.

关 键 词：颅脑损伤 创伤性脑梗死 危险因素 预后 

分 类 号：R651.15[医药卫生—外科学] R743.3[医药卫生—临床医学]