影响重型颅脑损伤患者大骨瓣减压术后预后的多因素分析

目的分析重型颅脑损伤(severe craniocerebral injury,sTBI)患者大骨瓣减压(decompressivecraniectomy,DC)术后的预后及相关因素。方法回顾分析121例DC术后患者的临床资料。出院1个月后,根据格拉斯哥预后评分(Glasgow outcome scale,GOS)分为预后不良组(n=72)和预后良好组(n=49),比较两组患者的年龄、性别、受伤至手术时间、入院时格拉斯哥昏迷评分(Glasgow coma scale,GCS)、瞳孔变化、术前中线移位、术前基底池形态、术前血糖等因素,Logistic多元回归分析影响预后的相关因素。结果单因素分析表明两组间受伤至手术时间、入院时GCS评分、瞳孔变化、术前中线移位、术前基地池形态和术前血糖差异有统计学意义(P<0.05);采用Logistic回归分析上述因素,影响预后的相关因素分别为入院时GCS评分、瞳孔变化、术前中线移位、术前基地池形态、受伤至手术时间和术前血糖。结论sTBI患者DC术后的预后与入院时GCS评分、术前中线移位、术前基地池形态、瞳孔变化、受伤至手术时间和术前血糖等因素有关。

Multivariate Analysis of the Factors on Prognosis in Patients with Severe Craniocerebral Injury after the Decompressive Craniectomy

Objective To analyze the prognosis and the related factors of severe craniocerebral injury patients with Decompressive Craniectomy(DC).Methods The clinical data of 121 DC patients were reviewed and analyzed.The patients were divided into two groups: poor prognosis group(n = 72) and good prognosis group(n = 49) based on Glasgow Outcome Scale(GOS) one month after discharge.Logistic multiple regression analysis was used to analyze the clinical data including age,sex,mean interval between injury and operation,admission Glasgow Coma Scale(GCS),and pupil change,preoperative midline shifted,compressed or obliterated basal cisterns and blood sugar.Results Single factor analysis showed that there were significant differences in the mean interval between injury and operation,admission GCS score,pupil changes,preoperative midline shifted,compressed or obliterated basal cisterns and blood sugar(P < 0.05).Logistic multiple regression revealed that the related factors associated with poor prognosis are admission GCS,pupil changes,preoperative midline shifted,compressed or obliterated basal cisterns,mean interval between injury and operation and blood sugar before the operation.Conclusion Prognosis for DC patients is associated with admission GCS,pupil change,preoperative midline shifted,compressed or obliterated basal cisterns,mean interval between injury and operation and blood sugar before the operation.