急诊重型颅脑损伤患者术后继发脑梗死的影响因素分析  

Analysis of the Influencing Factors of Secondary Cerebral Infarction after Surgery in Patients with Severe Craniocerebral Injury in the Emergency Department

作　　者：詹古文 孙吉林[2] 罗国林 ZHAN Guwen;SUN Jilin;LUO Guolin(Department of Emergency,Taizhou Fourth People’s Hospital,Taizhou 225300,China;Department of Neurosurgery,Taizhou Fourth People’s Hospital,Taizhou 225300,China)

机构地区：[1]泰州市第四人民医院急诊科,江苏泰州225300 [2]泰州市第四人民医院神经外科,江苏泰州225300

出　　处：《反射疗法与康复医学》2025年第5期77-80,共4页Reflexology And Rehabilitation Medicine

摘　　要：目的 分析急诊重型颅脑损伤患者术后继发脑梗死的危险因素。方法 回顾性分析2021年3月—2024年2月于泰州市第四人民医院行手术治疗的150例重型颅脑损伤患者的临床资料,根据是否继发脑梗死分为发生组(n=18)与未发生组(n=132)。收集两组患者的一般资料,并进行单因素分析与多因素Logistic回归分析以明确急诊重型颅脑损伤患者术后继发脑梗死的危险因素。结果 150例重型颅脑损伤患者中,18例术后继发脑梗死,继发率为12.00%(18/150)。单因素分析结果显示,两组性别、年龄、脑干损伤、硬膜下血肿、颅底骨折、脱水剂应用、弥散性血管内凝血评分、受伤至手术时间、手术时长、术中出血量比较,组间差异无统计学意义(P>0.05);两组格拉斯哥昏迷量表(GCS)评分、脑疝形成、合并低血压、蛛网膜下腔出血与重型颅脑损伤患者术后继发脑梗死有关,组间差异有统计学意义(P<0.05)。采用Logistic回归分析结果显示,GCS评分为3~5分(OR=3.875,95%CI=1.305~11.510)、脑疝形成(OR=2.875,95%CI=1.057~7.823)、合并低血压(OR=3.424,95%CI=1.227~9.558)、蛛网膜下腔出血(OR=3.280,95%CI=1.158~9.291)是影响重型颅脑损伤患者术后继发脑梗死的高危险因素(P<0.05且OR>1)。结论 急诊重型颅脑损伤患者术后有较高继发脑梗死的风险,主要与GCS评分为3~5分、脑疝形成、合并低血压、蛛网膜下腔出血有关,临床应注意采取相应预防措施进行干预,以改善患者疾病预后。Objective Analyze the risk factors for secondary cerebral infarction after surgery in patients with severe craniocerebral injury in the emergency department.Methods A retrospective analysis was conducted on the clinical data of 150 patients with severe craniocerebral injury who underwent surgical treatment at Taizhou Fourth People’s Hospital from March 2021 to February 2024.According to whether secondary cerebral infarction occurred or not,the patients were divided into the occurrence group(n=18)and the non-occurrence group(n=132).The general data of the patients in the two groups were collected,and univariate analysis and multivariate Logistic regression analysis were performed to identify the risk factors for secondary cerebral infarction after surgery in patients with severe craniocerebral injury in the emergency department.Results Among the 150 patients with severe craniocerebral injury,18 patients developed secondary cerebral infarction after surgery,with a secondary incidence rate of 12.00%(18/150).The results of the univariate analysis showed that in terms of the comparison of gender,age,brainstem injury,subdural hematoma,basilar skull fracture,application of dehydrating agents,disseminated intravascular coagulation score,time from injury to surgery,duration of surgery,and intraoperative blood loss between the two groups,and there was no statistically significant difference between the groups(P>0.05);the Glasgow Coma Scale(GCS)score,cerebral herniation formation,concurrent hypotension,and subarachnoid hemorrhage were related to the secondary cerebral infarction after surgery in patients with severe craniocerebral injury,and there were statistically significant differences between the two groups(P<0.05).The results of Logistic regression analysis showed that a GCS score of 3 to 5 points(OR=3.875,95%CI=1.305~11.510),cerebral herniation formation(OR=2.875,95%CI=1.057~7.823),concurrent hypotension(OR=3.424,95%CI=1.227~9.558),and subarachnoid hemorrhage(OR=3.280,95%CI=1.158~9.291)were high risk factors affect

关 键 词：重型颅脑损伤 急诊 脑梗死 影响因素 

分 类 号：R651.1.5[医药卫生—外科学]