颅脑外伤去骨瓣减压术后并发脑梗死危险因素分析

目的 探讨颅脑外伤患者去骨瓣减压术后并发脑梗死的相关危险因素,为其预防提供参考.方法 将68例颅脑外伤去骨瓣减压术后并发脑梗死患者作为观察组,另外89例未并发脑梗死患者作为对照组,对相关因素进行单因素及多因素回归分析.结果 颅脑外伤去骨瓣减压术后脑梗死发生率为43.3%,病死率为23.5%.单因素分析发现,年龄＞60岁、高血压、糖尿病、冠心病、陈旧性脑梗死、GCS昏迷评分＜8分、神经系统阳性体征、休克、急性硬膜下血肿、脑挫裂伤、损伤程度、入院时间与术后脑梗死发生相关.多因素分析发现年龄＞60岁、伴高血压、伴糖尿病、伴冠心病、伴陈旧性脑梗死、GCS昏迷评分＜8分、有神经系统阳性体征、轻度损伤、中度损伤、入院时间＜4 h为相关因素,其中轻度损伤、中度损伤、入院时间＜4 h为保护性因素,其余7项为危险因素.结论 年龄＞60岁、伴发心脑血管疾病或糖尿病、受伤程度、GCS评分等与颅脑外伤患者去骨瓣减压术后并发脑梗死相关,正确认识这些危险因素对其防治具有指导意义.

Risk factor analysis of complicated cerebral infarction after decompressive craniectomy for head trauma

Objective To explore the risk factors of complicated cerebral infarction after decompressive craniectomy for head trauma, and to provide references for the prevention. Methods 68 patients with complicated cerebral infarction after decompressive craniectomy for head trauma were chosen as observation group, and 89 patients without cerebral infarction were chosen as control group. The risk factors were analyzed through single factor analysis and muhifactor regression analysis. Results The incidence rate of complicated cerebral infarction after decompressive craniectomy for head trauma was 43.3 % , and the mortality was 23.5%. The single factor analysis indicated that the factors correlative with the occurrence of postoperative cerebral infarction included the age beyond 60 years old, hypertension, diabetes, coronary artery disease, old cerebral infarction, GCS score below 8 points, nerve system positive signs, shock,acute subdural hematoma, contusion and laceration of brain, injury degrees, and admission time. The muhifactor regression analysis indicated that the correlative factors including age beyond 60 years old, the complication of hypertension, diabetes, coronary artery disease, and old cerebral infarction, GCS score below 8 points, nerve system signs, minor injury, midrange injury, and admission time less than 4 h, in which the minor injury, midrange injury, and admission time less than 4 h were protective factors and the others were risk factors. Conclusion The age beyond 60 years old, the complication of cardiovascular and cerebrovascular diseases or diabetes,injury degrees, GCS scores are correlative with the complicated cerebral infarction after decompressive craniectomy for head trauma. Correction understanding of those risk factors has great significance for the prevention of complicated cerebral infarction.