老年重型颅脑损伤合并脑疝患者预后不良的危险因素分析  被引量:1

Analysis of risk factors for poor prognosis in elderly patients with severe brain injury complicated with cerebral hernia

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作  者:沈汉超 何炯周 田君 魏梁锋 王守森 Shen Hanchao;He Jiongzhou;Tian Jun;Wei Liangfeng;Wang Shousen(Department of Neurosurgery,The 900th Hospital,Fujian Medical University Fuzong Clinical Medical College,Fuzhou 350025,China)

机构地区:[1]福建医科大学福总临床医学院(第九〇〇医院)神经外科,福州350025

出  处:《中华神经创伤外科电子杂志》2023年第6期350-354,共5页Chinese Journal Of Neurotraumatic Surgery:Electronic Edition

基  金:联勤保障部队第九OO医院院内课题(2020Z04)。

摘  要:目的探讨老年重型颅脑损伤(sTBI)合并脑疝患者预后不良的危险因素。方法回顾性分析福建医科大学福总临床医学院神经外科和仓山院区神经外科收治的231例老年sTBI合并脑疝患者的临床资料。根据GOS评分将患者分为预后良好组和预后不良组,分析影响患者预后的相关因素,采用二元Logistic回归分析法筛选预后不良的独立危险因素。结果231例患者中,预后良好组106例,预后不良组125例。2组患者的年龄、性别、入院GCS评分、查尔森共病指数(CCI)、瞳孔反射异常、环池消失、术中并发脑膨出、中线结构移位、血氧饱和度<90%的占比比较,差异均有统计学意义(P<0.05)。二元Logistic回归分析显示,年龄>70岁、CCI≥2分、环池消失、血氧饱和度<90%、术中并发脑膨出是患者预后不良的独立危险因素。结论年龄>70岁、CCI≥2分、环池消失、血氧饱和度<90%、术中并发脑膨出是老年sTBI合并脑疝患者预后不良的独立危险因素。临床上应充分考虑这些危险因素,及时采取有效措施,改善患者预后。Objective To investigate the risk factors of poor prognosis in elderly patients with severe traumatic brain injury(sTBI)complicated with cerebral hernia.Methods The clinical data of 231 elderly patients with sTBI complicated with cerebral hernia were retrospectively analyzed,which were admitted to Neurosurgery Department of Fujian Medical University Fuzong Clinical Medical College and Neurosurgery Department of Cangshan Campus of Fujian Medical University.According to GOS score,the patients were divided into good prognosis group and poor prognosis group.The relevant factors affecting prognosis were screened out,and the independent risk factors affecting prognosis were found by binary Logistic regression analysis.Results Among the 231 patients,106 had a good prognosis and 125 had a poor prognosis.There were statistically significant differences between the two groups of patients in terms of age,gender,admission GCS score,Chalson comorbidity index(CCI),abnormal pupil reflex,disappearance of cisterna ambiens,intraoperative encephalocele,midline shift,and blood oxygen saturation<90%(P<0.05).Binary Logistic regression analysis showed that age>70 years old,CCI≥2 points,disappearance of the cisterna ambiens,blood oxygen saturation<90%,and intraoperative encephalocele were independent risk factors for poor prognosis.Conclusion Age>70 years old,CCI≥2 points,disappearance of the cisterna ambiens,blood oxygen saturation<90%,and intraoperative encephalocele are independent risk factors for poor prognosis in elderly patients with sTBI complicated with cerebral hernia.Clinically,these risk factors of poor prognosis should be fully considered and effective measures should be taken to improve the prognosis in time.

关 键 词:重型颅脑损伤 脑疝 老年患者 危险因素 

分 类 号:R651.15[医药卫生—外科学]

 

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