外伤性重型颅脑损伤并发迟发性颅内血肿预后相关影响因素分析

摘要

Objective To analyze the related factors influencing the prognosis of patients with delayed intracranial hematoma (DTICH) after traumatic severe traumatic brain injury (sTBI), and to provide reference for improving the prognosis of patients with DTICH. Method 161 patients with DTICH after sTBI in our hospital from July 2013 to July 2016 were divided into groups according to the quality of prognosis. The patients with good/moderate disability were included in good prognosis group, and the ones with severe disability/plant survival/death were included in poor prognosis group. The rate of poor prognosis of the two groups were calculated and the baseline data were compared. Multivariate Logistic regression analysis was used to analyze the risk factors of prognosis in patients with sTBI complicated with DTICH. Result Among 161 cases, 47 cases had poor prognosis (29.19%). Logistic multivariate regression analysis showed that age ≥60 years, deceleration injury associated injuries, complications, multiple hematomas, traumatic craniocerebral injury after the onset of Glasgow coma score (GCS) ≥13 points, DTICH after the onset of GCS score ≥13 points and DTICH > 60 ml were independent risk factors of prognosis in patients with sTBI complicated with DTICH (P < 0.05). Conclusion Age, severity of traumatic brain injury, nature of injury and type of hematoma can influence the prognosis of patients with sTBI complicated with DTICH. It is important to clear the patient's condition and pay attention to the treatment of complications, which can reduce the mortality and disability rate of patients.%目的 分析影响外伤性重型颅脑损伤并发迟发性颅内血肿患者预后的相关因素,为改善患者预后提供参考依据.方法 回顾性分析本院2013年7月至2016年7月收治的161例外伤性重型颅脑损伤并发迟发性颅内血肿患者的临床资料,按照预后质量,将恢复良好/中度残疾者纳入预后良好组,将重度残疾/植物生存/死亡者纳入预后不良组,计算患者预后不良率并比较两组患者基线资料,将存在统计学差异的因素纳入多因素Logistic回归分析,分析影响外伤性重型颅脑损伤并发迟发性颅内血肿患者预后的危险因素.结果 161例患者中,47例预后不良(29.19%).多因素Logistic回归分析显示,年龄≥60岁、减速伤、有合并伤、有并发症、多发性血肿、外伤性重型颅脑损伤发病后格拉斯哥昏迷评分(Glasgow coma score,GCS)≥13分、迟发性颅内血肿发病后GCS≥13分及迟发性颅内血肿出血量>60 ml是影响外伤性重型颅脑损伤并发迟发性颅内血肿患者预后的独立危险因素(P<0.05).结论 年龄、颅脑损伤严重程度、受伤性质及血肿类型均可影响外伤性重型颅脑损伤并发迟发性颅内血肿患者的预后,明确患者病情程度并注重并发症的处理,对降低患者病死率和病残率具有重要意义.