论文部分内容阅读
目的探讨多发伤合并颅脑损伤患者颅内血肿进展相关因素。方法笔者回顾性分析2007年1月~2014年1月收治的134例多发伤合并颅脑损伤患者的临床资料,其中男性91例,女性43例;年龄16~60岁,平均(35.6±10.7)岁。其中30例血肿进展患者为进展组,104例为未进展组,利用统计学方法对两组患者性别、年龄、伤情、格拉斯哥昏迷评分(GCS)、创伤严重度评分(ISS)、创伤严重指数(IISI)、休克指数、手术、凝血状况、液体复苏及血压调控等因素进行单因素及多因素分析。结果两组在年龄、性别、GCS、ISS评分、IISI、6h内的平均动脉压、休克指数、开颅手术情况对比无统计学意义。两组患者治疗前后休克指数均明显改善,比较无统计学意义。颅内血肿进展与48h平均动脉压(OR=1.994,P<0.001)、平均24h补液量(OR=0.342,P=0.038)、凝血功能异常情况(48h,OR=3.173,P=0.039)、多发脑挫裂伤情况(OR=2.921,P=0.041)相关。两组预后组间比较采用Ridit分析(R值_(进展)=0.590,R值_(未进展)=0.474,t=2.007,P=0.047),未进展组好于进展组。结论多发伤合并颅脑损伤患者颅内出血是影响预后的重要因素,多发脑挫裂伤患者更易出现,应予重视,通过限制性液体复苏和早期血压目标管理有利于减少血压波动和凝血功能异常发生,对改善患者预后有一定益处。
Objective To investigate the related factors of the progress of intracranial hematoma in patients with multiple trauma and craniocerebral injury. Methods The clinical data of 134 patients with traumatic brain injury complicated with traumatic brain injury admitted in our hospital from January 2007 to January 2014 were retrospectively analyzed. There were 91 males and 43 females, with a mean of (35.6 ± 10.7) years old ranging from 16 to 60 years. year old. Thirty cases of progression of hematoma progressed as progression group and 104 cases as progression group. The gender, age, injury, Glasgow coma score (GCS), trauma severity score (ISS), severe trauma index (IISI), shock index, surgery, coagulation status, fluid resuscitation and blood pressure control and other factors were univariate and multivariate analysis. Results There were no significant differences in mean arterial pressure, shock index and craniotomy between the two groups in age, gender, GCS, ISS score, IISI, 6h. The two groups of patients before and after treatment shock index were significantly improved, compared with no statistically significant. The progress of intracranial hematoma was related to the mean arterial pressure at 48h (OR = 1.994, P <0.001), mean 24h infusion volume (OR = 0.342, P = 0.038), coagulation abnormalities (48h, OR = 3.173, P = 0.039) Brain contusion (OR = 2.921, P = 0.041). Ridit analysis was used to compare outcomes between the two groups (R value_ (progression) = 0.590, R value_ (not progress) = 0.474, t = 2.007, P = 0.047), and progression group was better than progression group. Conclusions Intracranial hemorrhage is one of the most important prognostic factors in patients with traumatic brain injury and multiple traumatic brain injury. Patients with multiple cerebral contusion and laceration are more likely to be present and should be emphasized. Through restrictive fluid resuscitation and early management of target blood pressure, it is helpful to reduce the fluctuation of blood pressure and coagulation abnormalities , To improve the prognosis of patients have some benefits.