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目的探讨外伤性大面积脑梗死的形成原因及易发因素。方法对40例重型颅脑损伤患者临床资料进行回顾性研究,就梗死血管内外的可能因素,如血管外机械压迫因素(脑疝形成),血管内血流因素(休克、术中低血压、血渗透压、血钠、血糖以及年龄)进行Logistic回归分析。结果有27例患者伤后出现大面积脑梗死,与脑疝形成血管外持续压迫及血管内因素(休克以及术中低血压)关系密切,而与渗透压、血钠、血糖、年龄相关度不高。结论严重颅脑伤后并发大面积脑梗死形成是梗死血管内外多种因素共同作用的结果,与脑疝形成后的机械压迫作用以及休克、低血压后血容量、脑灌注不足的关系密切。
Objective To investigate the causes and the predisposing factors of traumatic large area cerebral infarction. Methods The clinical data of 40 patients with severe craniocerebral injury were retrospectively studied. The possible causes of infarct blood vessels, such as extravascular mechanical compression factors (herniation), intravascular blood flow factors (shock, intraoperative hypotension, blood Tonicity, serum sodium, blood glucose, and age) were analyzed by Logistic regression. Results A total of 27 patients had large-area cerebral infarction after injury, which was closely related to the continuous extravascular pressure suppression and intravascular factors (shock and intraoperative hypotension) of herniation hernia, but not related to osmotic pressure, serum sodium, blood glucose and age high. Conclusions Severe head injury complicated by large area cerebral infarction is the result of multiple factors both inside and outside the infarct. It is closely related to mechanical compression after formation of hernia and shock, blood volume after hypotension and cerebral perfusion insufficiency.