中重度颅脑外伤后脑梗死的危险因素分析

Risk factors for post traumatic cerebral infarction in patients with moderate or severe traumatic brain injury

摘要:

目的：探讨中重度颅脑损伤病人发生颅脑外伤后脑梗死（post traumatic cerebral infarction，PTCI）的危险因素。方法：筛选我院神经外科于2010年1月至2011年12月收治中重度颅脑损伤病人327例，进行回顾性研究，对可能引起PTCI的因素进行χ2检验分析，再行多因素的logistic回归分析。结果：发生PTCI 37（11.31%）例，其中低格拉斯哥昏迷评分（Glasgow coma scores，GCS）3～8分、9～12分患者PTCI发生率分别为16.11%（34/211）、2.59%（3/116），合并颅底骨折、外伤性蛛网膜下腔出血（subarach－noid haemorrhage，SAH）、脑疝、低血压性休克、去骨瓣减压术后患者PTCI发生率分别为19.74%（15/76）、14.89%（32/215）、17.95%（14/78）、20.00%（15/75）、14.61%（26/178），发生率差异具有统计学意义（P=0.001、0.031、0.029、0.039、0.001、0.043）。而患者年龄、性别不同引起的发生率差异没有统计学意义（P=0.353、0.882）。结论：GCS、颅底骨折、外伤性SAH、脑疝、低血压性休克、行去骨瓣减压术是PTCI发生的危险因素，而年龄、性别与PTCI发生无相关性。

Abstract:

Objective：To evaluate the risk factors for post traumatic cerebral infarction（PTCI） in patients with moderate or severe traumatic brain injury（TBI）. Methods：A retrospective review of 327 moderate or severe TBI patients admitted to our department between January 2010 and December 2011 was performed. Patients who had a history of cerebral infarction，severe heart disease，poorly controlled hypertension，hyperlipidemia and diabetes，and Glasgow coma scores（GCS） of more than 12 were excluded to avoid interfering factors. Patients who died during the first 3 d after the admission were also excluded. All cases were analyzed in aspects of gender，age，GCS，basal skull base fracture，traumatic subarachnoid hemorrhage（tSAH），cerebral hernia，low blood pressure or shock，decompression craniotomy. Statistical analysis was performed using chi-square and student’s t test. Multivariate analysis was per－formed using logistic regression to identify independent risk factors for the development of PTCI. Results：There were 37 cases（11.31%） suffering from PTCI. Attack rate of PTCI for patients with GCS 3-8 was 16.11%（34/211） while for patients with GCS 9-12 was 2.59%（3/116）. High attack rate of PTCI after moderate or severe TBI was also related with basal skull base fracture（19.74%，15/76），tSAH（14.89%，32/215），cerebral hernia（17.95%，14/78），low blood pressure or shock（20.00%，15/75） and decompression craniotomy（14.61%，26/178），with significant correlations（P=0.001，0.031，0.029，0.039，0.001，0.043）.While the patients’ age and gender were not associated with the development of PTCI（P=0.353，0.882）. Conclusions：Low GCS，basal skull base fracture，tSAH，cerebral hernia，low blood pressure or shock，and decompression craniotomy are risk factors for PTCI in patients with moderate or severe TBI. No association is observed between PTCI and gender or increasing age.