急性颅脑损伤后进展性出血性损伤危险因素分析

目的探讨急性颅脑损伤后发生进展性出血性损伤危险因素。方法分析274例你和性颅脑外伤患者临床资料,分为进展组86例和非进展组188例,对照分析两组相关因素。结果两组除首次头颅CT时间外,年龄、性别、GCS评分、瞳孔扩大、平均动脉压、合并颅骨折、合并硬膜外血肿、合并脑挫伤、合并蛛网膜下腔出血、双侧伤、首次CT血肿量、两次CT血肿量差之间差异,均有统计学意义(P均<0.05)。GCS<12分、瞳孔扩大、合并脑挫伤、合并蛛网膜下腔出血及首次CT血肿量>10ml为发生进展性出血性损伤的独立危险因素(P均<0.05)。结论急性颅脑损伤患者及时进行头颅CT检查,对血肿量>10ml,GCS评分1<12分、瞳孔扩大及合并脑挫伤和蛛网膜下腔出血患者,应密切观察病情进展,尽早复查头颅CT以及时发现进展性出血性损伤。

Evaluation on the risk factors of progressive hemorrhagic injury after acute traumatic brain injury

Objective To evaluated the independent risk factors of the occurrence of progressive hemorrhagic injury after acute traumatic brain injury. Methods 274 cases of traumatic brain injury patients admitted in our hospital were retrospectively analyzed. The 86 cases with progressive hemorrhagic injury were included in progressive group. The other 188 cases were included in non-progressive group. The incidence of pro- gressive hemorrhagic injury was calculated. Results The age, gender, GCS score when admitted in hospital, mydriasis, mean arterial pressure, skull fracture, epidural hematoma, cerebral contusion, bilateral injury, subarachnoid hemorrhage, volume of hematoma at the first CT scanning time, the change of cerebral heatoma influence the development of progressive hemorrhagic injury （P〈0.05）. GCS score less than 12, mydriasis, cerebral contusion, subarachnoid hemorrhage and volume of hematoma more than 10 ml at the first CT scanning are the independent risk factors of the progressive hemorrhagic injury after traumatic brain injury. Conclusion GCS score less than 12, mydriasis, cerebral contusion, subarachnoid hemorrhage and volume of hematoma more than 10 ml at the first CT scanning are the independent risk factors of the progressive hemorrhagic injury after traumatic brain injury. Early repeated CT scanning contributed to early diagnosis of progressive hemorrhagic injnry and improve the outcome.