CAJ | 학술논문

目的探讨中重型颅脑损伤后进展性出血性损伤(PHI)的相关危险因素,为其早期诊治和有效预防提供依据.方法选取湖南省长沙市中医医院神经外科自2007年8月至2009年2月收治的颅脑损伤患者262例(发生PHI 125例,未发生PHI 137例),多因素Logistic回归分析患者的年龄、性别、出血部位、出血类型、瞳孔情况、入院时收缩压、伤后至首次CT时间、GCS评分、受伤机制、首次CT和第2次CT的间隔时间、大剂量应用甘露醇、血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)对PHI发生的影响.结果单因素分析显示年龄、出血类型、伤后至首次CT时间、GCS评分、PLT、PT、APTT对PHI发生的影响具有统计学意义(P＜0.05).多因素Logistic回归分析显示伤后至首次CT时间、GCS评分、PLT是PHI发生的独立危险因素,OR值分别为3.5448、3.0975、2.2361.结论对于首次CT检查时间较早、GCS评分低、PLT较低的中重型颅脑损伤患者,要警惕PHI的发生,及时行正规的动态CT复查,提高PHI的诊断和救治成功率.
목적 탐토중중형로뇌손상후진전성출혈성손상(PHI)적상관위험인소,위기조기진치화유효예방제공의거.방법 선취호남성장사시중의의원신경외과자2007년8월지2009년2월수치적로뇌손상환자262례(발생PHI 125례,미발생PHI 137례),다인소Logistic회귀분석환자적년령、성별、출혈부위、출혈류형、동공정황、입원시수축압、상후지수차CT시간、GCS평분、수상궤제、수차CT화제2차CT적간격시간、대제량응용감로순、혈소판계수(PLT)、응혈매원시간(PT)、활화부분응혈매원시간(APTT)대PHI발생적영향.결과 단인소분석현시년령、출혈류형、상후지수차CT시간、GCS평분、PLT、PT、APTT대PHI발생적영향구유통계학의의(P＜0.05).다인소Logistic회귀분석현시상후지수차CT시간、GCS평분、PLT시PHI발생적독립위험인소,OR치분별위3.5448、3.0975、2.2361.결론 대우수차CT검사시간교조、GCS평분저、PLT교저적중중형로뇌손상환자,요경척PHI적발생,급시행정규적동태CT복사,제고PHI적진단화구치성공솔.
Objective To study the risk factors related with progressive hemorrhagic injury (PHI)after severe head injury for a view to early diagnosis and treatment for this disease and providing a basis for effective prevention. Methods In a retrospective study of 262 patients with severe brain injury in considering the clinical data of the PHI, the occurrence is variable, and age, gender, bleeding site, type of bleeding, dilated pupils starus, level of systolic blood pressure on admission, time of CT for the first time,GOS scores, injured mechanism, interval between first and second time CT, application of high-dose mannitol, platelet (PLT) count, prothrombin time (PT), activated partial prothrombin time (APTT) were considered as independent variables. Results The incidence rate of having PHI was 47.7% (125/262);single-factor analysis revealed that, as compared with those in patients with non-PHI, 7 factors in patients with PHI were significantly different, namely, age, type of hemorrhage, interval between injury and first-time CT, GCS scores, PLT count, PT and APTT. Multivariate logistic regression analysis of the results showed that interval between injury and first-time CT, GCS scores, PLT count were the risk factors of having PHI, and their OR values were 3.5448, 3.2975 and 2.2361, respectively. Conclusion For patients with severe brain injury, the sooner the first time CT examination is performed, the lower the GCS scores are and the lower the PLT count is, the higher risk of having PHI is. Thus, dynamic CT formal review is suggested to improve the early diagnosis and treatment of PHI.