颅脑外伤患者改良大骨瓣开颅手术后脑血流变化规律及其与患者预后的关系  

Relationship between cerebral blood flow and prognosis in patients with traumatic brain injury after modified large trauma craniotomy

作　　者：吕光淘 张晓强[1] 黄小龙 黄浩 孙凌云[1] LYU Guangtao;ZHANG Xiaoqiang;HUANG Xiaolong;HUANG Hao;SUN Lingyun(Department of Neurosurgery,Guang'an People's Hospital,Guang'an Sichuan 638000,China)

机构地区：[1]广安市人民医院神经外科,四川广安638000

出　　处：《中国急救复苏与灾害医学杂志》2025年第2期242-247,共6页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：四川省科技计划(编号:SL-284A3)。

摘　　要：目的探究改良大骨瓣开颅手术后颅脑外伤患者脑血流变化规律及其与患者预后的关系。方法选取了124例颅脑外伤患者作为研究对象,根据患者的预后情况,将其分为预后良好组77例和预后不良组47例。采用多因素Logistic回归和基于赤池信息量准则(AIC)分析颅脑外伤患者预后的危险因素,Joint模型评估脑血流变化对预测患者预后的价值,并建立多元线性回归模型。结果年龄、受伤至入院时间、入院时急性生理学和慢性健康状况(APACHEⅡ)评分、急性脑膨出、切口疝和感染等方面的差异在两组患者中具有统计学意义(P<0.05)。多因素Logistic回归分析结果发现,年龄、受伤至入院时间、入院时APACHEⅡ评分、大脑前、中、后动脉平均流速、急性脑膨出、切口疝以及感染均是颅脑外伤患者预后不良的独立危险因素(P<0.05)。通过逐步回归方法评估了每个临床因素对预后的重要性,并根据AIC对这些临床因素进行了排序,发现影响颅脑外伤预后的因素包括年龄、受伤至入院时间、入院时APACHEⅡ评分、大脑前、中、后动脉平均流速、急性脑膨出、切口疝以及感染。多因素COX风险比例模型在训练集和验证集上都呈现出高度一致的预后模型,显示出这些因素构成的多因素模型的相似性较高。术后两组患者的脑血流速度先升高再下降,在第3天达到顶峰。术后良好组大脑前、中、后动脉平均流速低于不良组。Joint模型结果显示,大脑前动脉平均血流速每纵向上升1 cm/s,预后不良的风险增加3%;大脑中动脉平均血流速每纵向上升1 cm/s,预后不良的风险增加4%;大脑后动脉平均血流速每纵向上升1 cm/s,预后不良的风险增加3.5%。多元线性回归结果显示,年龄、受伤至入院时间、入院时APACHEⅡ评分、大脑前、中、后动脉平均流速、急性脑膨出、切口疝、感染对应的线性系数差异有统计学意义(P<0.05)Objective To explore the changes of cerebral blood flow in patients with traumatic brain injury after modified large trauma craniotomy and its relationship with the prognosis of the patients.Methods A total of 124 patients with craniocerebral trauma were selected as the study objects.According to the prognosis of the patients,they were divided into good prognosis group with 77 cases and bad prognosis group with 47 cases.Multivariate Logistic regression and Akaike information information criterion(AIC)were used to analyze the prognostic risk factors of patients with craniocerebral trauma.The Joint model was used to evaluate the value of cerebral blood flow changes in predicting the prognosis of patients,and a multiple linear regression model was established.Results Age,time from injury to admission,Acute physiology and Chronic health status(APACHE II)scores at admission,acute encephalocele,incisional hernia and infection were significantly different between the two groups(P<0.05).According to the results of multivariate Logistic regression analysis,it was found that age,time from injury to admission,APACHEⅡscore on admission,mean velocity of anterior cerebral artery,mean velocity of middle cerebral artery,mean velocity of posterior cerebral artery,acute encephalocele,incicular hernia and infection were related to the poor prognosis of patients with craniocerebral trauma(P<0.05).And they are independent risk factors.Using a stepwise regression approach,the importance of each clinical factor on prognosis was assessed and these clinical factors were ranked according to AIC.Found that the effect of prognosis of craniocerebral trauma,including age,injury to admission time,APACHEⅡscore on admission,the average velocity of the anterior cerebral artery,mean velocity of middle cerebral artery,posterior cerebral artery average flow velocity,acute encephalocele,infection of incision hernia and.The multivariate COX proportional hazard model presented highly consistent prognostic models in both the training set and the val

关 键 词：颅脑外伤 改良大骨瓣开颅手术 脑血流速度 预后 

分 类 号：R651.15[医药卫生—外科学]