CAJ | 학술논문

目的筛选重型颅脑损伤患者开颅术中低血压发生的危险因素.方法选择18岁以上重型颅脑损伤急诊开颅患者175例,性别不限.根据术中是否发生低血压(收缩压＜90 mm Hg或降.低幅度大于基础值的30％)分为低血压组和无低血压组.记录患者性别、年龄、术前格拉斯哥昏迷量表(GCS)评分、瞳孔、术前收缩压、甘露醇使用情况、过度通气,麻醉诱导方法、梯度降低颅压情况.将组间差异有统计学意义的因素进行多因素logistic回归分析,筛选该类患者发生术中低血压的独立危险因素.结果 50例患者发生了术中低血压,发生率为28.6％.与无低血压组比较,低血压组术前收缩压、GCS评分与瞳孔变化差异有统计学意义(P＜0.05).logistic回归分析结果显示,术前收缩压是重型颅脑外伤患者开颅术中发生低血压的独立危险因素(P＜0.05),其OR值(95％可信区间)为1.019(1.005 ～ 1.033),回归系数为0.019.结论术前收缩压是重型颅脑损伤患者开颅术中低血压发生的独立危险因素.
목적 사선중형로뇌손상환자개로술중저혈압발생적위험인소.방법 선택18세이상중형로뇌손상급진개로환자175례,성별불한.근거술중시부발생저혈압(수축압＜90 mm Hg혹강.저폭도대우기출치적30％)분위저혈압조화무저혈압조.기록환자성별、년령、술전격랍사가혼미량표(GCS)평분、동공、술전수축압、감로순사용정황、과도통기,마취유도방법、제도강저로압정황.장조간차이유통계학의의적인소진행다인소logistic회귀분석,사선해류환자발생술중저혈압적독립위험인소.결과 50례환자발생료술중저혈압,발생솔위28.6％.여무저혈압조비교,저혈압조술전수축압、GCS평분여동공변화차이유통계학의의(P＜0.05).logistic회귀분석결과현시,술전수축압시중형로뇌외상환자개로술중발생저혈압적독립위험인소(P＜0.05),기OR치(95％가신구간)위1.019(1.005 ～ 1.033),회귀계수위0.019.결론 술전수축압시중형로뇌손상환자개로술중저혈압발생적독립위험인소.
Objective To identify the risk factors for the development of hypotension during craniotomy in patients with severe traumatic brain injury (TBI).Methods One hundred and seventy-five patients,aged ≥ 18 yr,undergoing emergency craniotomy for TBI,were selected.According to the occurrence of intraoperative hypotension (systolic pressure ＜ 90 mm Hg or the decreased amplitude ＞ 30％ of the baseline),all the patients were divided into 2 groups:hypotension group and non-hypotension group.The data including gender,age,preoperative Glasgow Coma Scale (GCS) score,pupils,preoperative systolic pressure,application of mannitol,hyperventilation,methods for induction of anesthesia,and decrease in intracranial pressure were recorded.The risk factors of which P values were less than 0.05 would enter the multi-factor logistic regression analysis to stratify the independent risk factors for intraoperative hypotension.Results Fifty patients developed intraoperative hypotension,and the incidence was 28.57％.There was significant difference in preoperative systolic pressure,GCS score and changes in pupils between hypotension group and non-hypotension group (P ＜ 0.05).Logistic regression analysis showed that preoperative systolic pressure was the independent risk factor for hypotension during craniotomy in patients with severe TBI (P ＜ 0.05),and OR value (95％ confidence interval) was 1.019 (1.005-1.033),and regression coefficient was 0.019.Conclusion Preoperative systolic pressure is the independent risk factor for hypotension during craniotomy in patients with severe TBI.