外伤后动脉性大面积脑梗死的相关危险因素分析

目的分析外伤致动脉性大面积脑梗死（AMCI）的相关危险因素。 方法选取解放军总医院第四医学中心神经外科自2015年4月至2018年5月收治的103例颅脑损伤患者为研究对象，根据CTA或DSA将患者分为AMCI组与非动脉性大面积脑梗死（NAMCI）组，对2组患者的性别、年龄、GCS评分、受伤至入院时间、环池状态、外伤性蛛网膜下腔出血（tSAH）、收缩压（SBP）、渗透压（OP）、中心静脉压（CVP）、凝血功能、乳酸（Lac）及脑挫伤12项指标进行单因素分析，再次将差异有统计学意义的指标行Logistic多因素回归分析，采用GOS评分判断预后。 结果单因素分析显示：年龄、GCS评分、CVP、SBP、OP、tSAH、环池状态、Lac 8个指标与AMCI发生相关（P<0.05）；Logistic多因素回归分析显示：GCS≤8分、CVP≤5 cmH₂O（1 cmH₂O=0.098 kPa）、OP<270 mmol/L、SBP≤90 mmHg（1 mmHg=0.133 kPa）是动脉性脑梗死的独立危险因素（P<0.05）；采用GOS评分评价预后：良好8例、中残9例、重残7例、死亡4例。 结论低GCS评分、低CVP、低OP、低SBP是动脉性脑梗死的独立危险因素，重点评估和监测上述指标对该病的救治有重要的临床意义。

Analysis of risk factors for post-traumatic arterial massive cerebral infarction

ObjectiveTo analyze the relative risk factors for arterial massive cerebral infarction (AMCI) caused by trauma. MethodsOne hundred and three patients with craniocerebral injury admitted to Department of Neurosurgery, Fourth Medical Center of PLA General Hospital from April 2015 to May 2018 were divided into AMCI group and NAMCI group according to CTA or DSA. Gender, age, GCS score, time from injury to admission, cistern state, traumatic subarachnoid hemorrhage (tSAH), systolic blood pressure (SBP), osmotic pressure (OP), central venous pressure (CVP), coagulation function and milk of the two groups were compared. Single factor analysis was performed on 12 indicators of acid (Lac) and brain contusion. Logistic multivariate regression analysis was performed on the indicators with statistical significance, and GOS score was used to judge the prognosis. ResultsThe univariate analysis showed that 8 indexes, including age, GCS score, CVP, SBP, OP, tSAH, cistern state and Lac, were closely related to the occurrence of AMCI (P<0.05). By multivariate Logistic regression analysis, GCS≤8, CVP≤5 cmH₂O (1 cmH₂O=0.098 kPa), OP<270 mmol/L and SBP≤90 mmHg (1 mmHg=0.133 kPa) were independent risk factors of arterial cerebral infarction (P<0.05). According to GOS, there were good in 8 cases, moderate disability in 9 cases, severe disability in 7 cases, and death in 4 cases. ConclusionLow GCS score, low CVP, low OP and low SBP are independent risk factors for cerebral arterial infarction. It is important clinical significance for treatment and cure of the disease to focus on the above indexes assessment and monitoring.