重型颅脑损伤继发脑梗死临床特点及相关危险因素分析

目的 探讨颅脑损伤继发创伤性脑梗死（TCI）的临床特点及其相关危险因素.方法 选取480例颅脑损伤患者为研究对象,根据是否发生TCI将患者分为TCI组及非TCI组,观察TCI组患者临床症状、体征,分析其相关危险因素.结果 480例患者中,30例发生TCI,发生率为6.25%.临床表现包括偏侧肢体运动及感觉功能障碍,视觉功能异常,语言功能异常,头晕头痛.预后良好10例,轻度残疾6例,重度残疾3例,植物生存1例,死亡10例.单因素分析显示TCI组患者年龄≥50岁、GCS评分＜8分、存在脑疝、存在低血压、伴有蛛网膜下腔出血、应用大剂量脱水剂的比例高于非TCI组,差异均有统计学意义（x2=12.311 3、14.725 4、19.867 8、5.296 9、9.242 6、11.713 6,均P＜0.05）.Logistic多因素分析显示,年龄≥50岁、GCS评分＜8分、存在脑疝、存在低血压为颅脑损伤继发TCI重要危险因素.结论 颅脑损伤继发TCI患者临床表现具有一定特点,年龄≥50岁、GCS评分＜8分、存在脑疝、存在低血压为颅脑损伤继发脑梗死重要危险因素.

Clinical characteristics and related risk factors of Infarction secondary to severe traumatic brain injury

Objective To investigate the clinical characteristics and related risk factors of infarction secondary to severe traumatic brain injury.Methods 480 traumatic brain injury patients were chosen.Depending on the occurrence of cerebral infarction,patients were divided into TCI groups and non-TCI group,clinical symptoms and signs of TCI group were observed,and its related risk factors was analyzed.Results In 480 cases patients,there were 30 cases of patients with traumatic brain injury secondary to cerebral infarction,the rate was 6.25%.Clinical manifestations included unilateral limb motor and sensory dysfunction,visual dysfunction,language dysfunction,dizziness,headache.10 cases Prognosis were good,6 cases were mild disability,3 cases were severe disability,1 case was plant survival,10 patients died.Univariate analysis showed that the rates of aged ≥50 years,GCS score 〈 8 points,hernia,hypotension,subarachnoid hemorrhage,large doses of non-dehydrating agent in the TCI group were higher than those of non-TCI group,the differences were statistically significant （χ^2 =12.311 3,14.725 4,19.867 8,5.296 9,9.242 6,11.713 6,all P 〈 0.05）.Logistic multivariate analysis showed that age ≥50 years,GCS score 〈 8 points,hernia,cerebral hypotension were important risk factors.Conclusion Brain injury patients with cerebral infarction secondary to clinical manifestations have some characteristics.Age ≥50 years,GCS score 〈 8 points,hernia,hypotension are important risk factors.