中重度颅脑损伤继发急性脑梗死的相关危险因素和预后分析

摘要

Objective To explore risk factors and prognosis of acute posttraumatic cerebral infarction (PTCI)in patients with moderate or severe traumatic brain injury(TBI).Methods 218 patients with moderate or severe TBI were analyzed,PTCI was observed in 27 (12.4%)of the 218 patients within the first week after injury.218 patients with moderate or severe TBI were retrospectively reviewed to determine the incidence and timing of PTCI and to evaluate the effects of age,gender,admission Glasgow coma scores(GCS),brain herniation,intracranial hypertension, hypocapnia,low systolic blood pressure,DIC score,infection an decompressive craniectomy on the development of cerebral infarction.Risk factors for PTCI and prognosis factors of TBI patients were evaluated using logistic regression analysis.Results Of 218 patients identified with moderate or severe TBI,27 (12.4%)had confirmed PTCI.In multivariate analysis,gender,age,hypocapnia, infection,decompressive craniectomy were not associated with PTCI;whereas admission GCS (OR 7.004,95% CI 2.965 -15.894),brain herniation (OR 6.954,95% CI 2.872 -14.997 ), intracranial hypertension(OR 6.854,95%CI 2.781 -15.432),Lower systolic blood pressure(OR 7.128,95% CI 3.032 -16.124)and DIC score(OR 6.365,95%CI 2.549 -15.238)were each independently associated with an increased risk of PTCI.Low admission GCS score (3 -5 )(OR 6.545,95% CI 2.845 -16.011 ),brain herniation (OR 5.246,95%CI 2.487 -13.997),low systolic blood pressure(OR 6.836,95%CI 2.834 -16.424),DIC score(≥5)(OR 7.062,95%CI 3.551 -16.927),infection (OR 4.574,95% CI 1.965 -12.295)and the presence of PTCI(OR7.221,95% CI 3.665 -16.982 )showed an independent predictive effect on poor outcome. Conclusions The incidence of PTCI in patients with severe TBI is higher than previously thought. Admission GCS,brain herniation ,intracranial hypertension,low systolic blood pressure,and DIC score are risk factors for PTCI.Low admission GCS score(3 -5),brain herniation,low systolic blood pressure,DIC score(≥5),infection and the presence of PTCI are independent predictive factors on poor outcome in TBI.%目的：探讨中重度颅脑外伤患者继发急性外伤性脑梗死（PTCI）的危险因素和预后。方法回顾性分析218例中重度颅脑外伤患者的临床资料，其中27例伤后1周内出现 PTCI。通过多因素 Logistic回归分析，分析患者的性别、年龄、入院格拉斯哥昏迷量表（GCS）评分、是否合并脑疝、颅内压、血压、血气分析中 CO2值、DIC 评分、是否合并感染、有无实施去骨瓣减压术共10个因素与 PTCI 的关系，以及对患者预后的影响。结果经过统计学分析，患者的入院 GCS 评分、合并脑疝、颅高压、低血压、DIC 评分是发生PTCI 的独立危险因素，而年龄、性别、CO2值、合并感染以及有无实施去骨瓣减压术与 PTCI 无明显相关性。入院 GCS 评分低（3～5分）、合并脑疝、低血压、DIC 评分≥5分、合并感染、继发 PTCI 是患者预后不良的独立预测因素。结论中重度颅脑外伤患者入院 GCS 评分、合并脑疝、颅高压、低血压、DIC 评分是发生 PTCI的独立危险因素；入院 GCS 评分低、合并脑疝、低血压、DIC 评分≥5分、合并感染、继发 PTCI 的患者预后差，致残率高。