重型颅脑创伤并发大面积脑梗死的成因及外科治疗探讨

目的探讨重型颅脑创伤并发大面积脑梗死的成因及外科治疗效果。方法回顾性分析了2006年6月至2012年6月入住我院的36例重型颅脑创伤合并大面积脑梗死患者的临床资料,采用单因素与Logistic多元回归分析的方法,对引起该病的因素进行探讨,然后采用外科手术对其进行治疗。结果①单因素分析结果:重型颅脑创伤并发大面积脑梗死发病与瞳孔变化、GCS评分、年龄、合并伤、围手术期血压、中线移位以及环池状态等因素有关(P<0.05);②Logistic多元回归分析结果:瞳孔散大与围手术期低血压可能是引起重型颅脑创伤合并大面积脑梗死的独立危险因素;③治疗结果:12例死亡,剩余24例出院后随访2~18个月,平均(9.3±0.8)个月,恢复良好16例,8例中至重残。结论重型颅脑创伤并发大面积脑梗死的成因可能为瞳孔散大及围术期血压低;该病可能会导致进一步地重脑损害,应该对其进行早期、及时地诊断,并采取综合治疗,能够明显改善患者的生存质量及预后。

Causes and Surgical Therapy of Severe Traumatic Brain Injury Complicated by Massive Cerebral Infarction

Objective To investigate the severe traumatic brain injury concurrent causes and surgical treatment of massive cerebral infarction. Methods 36 cases of patients with severe traumatic brain injury merger massive cerebral infarction were analyzed during 2006.7-2012.7, and the single factors＇ analysis and Logistic analysis were used to discuss the influential factors of this disease, and then the treatment of surgery was used. Results （1）single-factor analysis results： severe traumatic brain injury complicated by a large area of cerebral infarction and pupillary changes, GCS score, age, associated injuries, perioperative blood pressure, midline shift, as well as factors such as ambient cistern status （P〈0.05）; （2）Logistic multiple regression analysis： mydriasis and perioperative hypotension may be an independent risk factor for causing severe craniocerebral trauma with massive cerebral infarction; （3）treatment results： 12 deaths, and the remaining 24 cases of post-discharge follow-up of 2 to 18 months, on average （9.3 ± 0.8） months, good recovery in 16 cases, eight cases of severe disability. Conclusion The concurrent massive cerebral infarction causes severe traumatic brain injury may mydriasis large and perioperative blood pressure; disease may lead to further heavy brain damage, and should be carried out early and timely diagnosis and comprehensive treatment can significantly improve the patient＇s quality of life and prognosis.