轻中度创伤性脑损伤后发生进展性出血性损伤的危险因素分析

摘要

目的：探讨轻中度[格拉斯哥昏迷量表（Glasgow coma scale，GCS）≥9]创伤性脑损伤（traumatic brain injury， TBI）后发生进展性出血损伤（progressive hemorrhagic injury，PHI）的相关危险因素。方法回顾性分析2013年9月～2015年8月132例轻中度 TBI 患者颅内出血进展情况，41例（31．1％）进展为 PHI（PHI 组）。单因素分析包括性别、年龄、受伤原因、损伤类型、瞳孔大小、瞳孔对光反应、入院时高血压（收缩压≥140 mm Hg）、受伤到首次 CT 检查时间、血肿部位、血肿类型、是否合并脑挫裂伤、是否合并蛛网膜下腔出血，以及入院首次凝血功能指标、血糖、血常规、肾功能，出院时格拉斯哥预后评分（Glasgow outcome scale，GOS），并应用 logistic 回归进行多因素分析。结果单因素分析显示年龄、损伤类型、入院时高血压、合并脑挫裂伤、合并蛛网膜下腔出血、D －二聚体、红细胞计数、血糖和出院 GOS 评分的差异有统计学意义（P ＜0．05）。多因素分析显示入院时高血压（OR ＝2．417，P ＝0．045），合并脑挫裂伤（OR ＝2．792，P ＝0．017）和 D －二聚体≥6500μg ／L（OR ＝4．968，P ＝0．000）是独立危险因素。结论轻中度 TBI 患者若存在入院时高血压、合并脑挫裂伤和较高水平 D －二聚体（≥6500μg ／L）更易发生 PHI，需要加强监测。%Objective To research risk factors related to progressive hemorrhagic injury (PHI) after mild to moderate (Glasgow coma scale ≥ 9 )traumatic brain injury (TBI). Methods A retrospective study was made on 132 cases of mild to moderate traumatic brain injury between September 2013 and August 2015,among which 41 (31 .1 %)cases were deteriorate to PHI (PHI group).The univariate analysis included gender,age,injury mechanism,type of injury,pupillary size,reaction of pupil to light,hypertension on admission (level of systolic blood pressure ≥ 140 mm Hg),time of CT scanning for the first time,hematoma location,hemorrhage types,combined brain contusion,combined subarachnoid hemorrhage,first blood coagulation function index, blood glucose,routine blood test and renal function on admission,and Glasgow outcome scale(GOS)score at discharge.The logistic regression was used to analyze multiple factors. Results Univariate logistic regression indicated that the age,type of injury,high blood pressure on admission,combined brain contusion,combined subarachnoid hemorrhage,plasma D-dimmer values,RBC,blood glucose and GOS scores at discharge had significantly statistical differences between the two groups (P <0.05).Multivariate analysis showed high blood pressure on admission (OR =2.417,P =0.045 ),combined brain contusion (OR =2.792,P =0.017 )and D-dimmer level ≥ 6500 μg /L (OR =4.968,P =0.000)were independent statistically significant risk factors of PHI. Conclusion PHI with TBI is common in patients with high blood pressure on admission,combined brain contusion and higher D-dimmer level (≥ 6500 μg /L).These patients should be given intensive care.