颅脑损伤术后患者并发创伤性脑梗死的预防及风险因素分析

目的 探讨颅脑损伤术后患者并发创伤性脑梗死(TCI)的风险因素，为其预防和治疗提供参考。 方法 收集金华市中心医院2011年1月—2014年1月神经外科收治的颅脑损伤患者277例，所有患者均行开颅手术，根据术后是否并发有创伤性脑梗死，将患者分为观察组26例、对照组251例，应用单因素分析2组患者的年龄、性别、BMI、是否合并高血压、冠心病、入院时高血糖、有无合并伤、有无脑梗死病史、手术方式、颅脑损伤类型、脑梗死类型、GCS评分、是否合并脑疝及是否合并恶性脑水肿，并进一步应用多因素非条件Logistic回归分析颅脑损伤术后患者并发创伤性脑梗死的风险因素。 结果 共有26例患者术后并发脑梗死，发生率为9.4%，术前高血糖、硬膜下血肿、行大骨瓣减压术、GCS小于8分、合并脑疝及恶性脑肿胀与颅脑损伤术后发生相关(P＜0.05)，应用Logistic回归分析颅脑损伤术后发生创伤性脑梗死风险的多因素分析结果显示，患者术前高血糖、GCS小于8分、合并脑疝及合并恶性脑肿胀可增加颅脑损伤术后发生创伤性脑梗死的风险(P＜0.05)。 结论 术前高血糖、GCS小于8分、合并脑疝及合并恶性脑肿胀可增加颅脑损伤术后发生TCI的独立风险因素，在颅脑损伤后的TCI防治中应加强干预。 

Prevention and risk factors of traumatic cerebral infarction in patients with craniocerebral injury

Objective To determine the prevention and risk factors of traumatic cerebral infarction in patients with brain injury,so as to improve its prevention and treatment. Methods Total 277 cases of brain injury patients admitted to our hospital from January,2011 to January,2014 in our hospital were collected.All patients underwent craniotomy,according to whether there was a traumatic cerebral infarction,patients were divided into observation group of 26 cases,251 cases in the control group.Application of single factor analysis of two groups of patients with age,sex,BMI,whether the merger of hypertension,coronary heart disease and admission hyperglycemia,combined injury,cerebral infarction history,mode of operation,type of brain injury,types of cerebral infarction,GCS score,whether complicated with cerebral hernia and whether complicated with malignant brain edema.The risk factors of traumatic cerebral infarction in patients with craniocerebral injury were analyzed by multifactor non-conditional Logistic regression analysis. Results A total of 26 patients complicated with cerebral infarction.The occurrence rate was 9.4%.Preoperative hyperglycemia,subdural hematoma,decompressive craniectomy,GCS less than eight score,combined with cerebral hernia and malignant brain swelling was related with the brain injury after operation occurred(P<0.05). Conclusion Peoperative hyperglycemia,GCS less than eight score,combined with cerebral hernia and associated with malignant brain swelling increase the independent risk factors of traumatic cerebral infarction after craniocerebral injury operation.Intervention should be strengthened in the prevention and treatment of traumatic cerebral infarction after traumatic brain injury.