浙江大学学报（医学版）
浙江大學學報（醫學版）
절강대학학보（의학판）
Journal of Zhejiang University (Medical Sciences)
2015年
4期
410-416
,共7页
王科%赵冬青%张建军%李玉健%张海栋%沈张锋%胡兵%吴海滨
王科%趙鼕青%張建軍%李玉健%張海棟%瀋張鋒%鬍兵%吳海濱
왕과%조동청%장건군%리옥건%장해동%침장봉%호병%오해빈
格拉斯哥昏迷评分%颅脑损伤/死亡率%颅脑损伤/流行病学%死亡原因%危险因素%蛛网膜下腔出血%糖尿病,2型%预后
格拉斯哥昏迷評分%顱腦損傷/死亡率%顱腦損傷/流行病學%死亡原因%危險因素%蛛網膜下腔齣血%糖尿病,2型%預後
격랍사가혼미평분%로뇌손상/사망솔%로뇌손상/류행병학%사망원인%위험인소%주망막하강출혈%당뇨병,2형%예후
Glasgow Coma Score%Craniocerebral trauma/mortality%Craniocerebral trauma/epidemiology%Cause of death%Risk factors%Subarachnoid hemorrhage%Diabetes mellitus,type 2%Prognosis
目的：探讨脑挫裂伤患者发生进展性脑挫裂伤的高危因素及与预后的相关性。方法：收集在浙江萧山医院就诊的脑挫裂伤病例共132例，按是否发生进展性脑挫裂伤分为进展性脑挫裂伤组（70例）与非进展性脑挫裂伤组（62例），对相关危险因素进行单因素分析和多因素Logistic回归分析，并比较两组患者6个月的预后。结果：单因素分析结果显示入院时格拉斯哥昏迷评分（ GCS ）、首次颅脑CT检查显示脑挫裂伤体积、中线移位、合并有颅骨骨折、蛛网膜下腔出血、硬膜外血肿、硬膜下血肿、2型糖尿病及脑挫裂伤部位、血清D－二聚体水平是进展性脑挫裂伤的影响因素。多因素Logistic回归分析结果显示GCS、首次颅脑CT检查显示脑挫裂伤体积、合并蛛网膜下腔出血、合并2型糖尿病是进展性脑挫裂伤的独立危险因素，进展性脑挫裂伤患者预后更差（ P＜0．01）。结论：意识障碍、脑挫裂伤范围大、合并有蛛网膜下腔出血及2型糖尿病是进展性脑挫裂伤的高危因素，此类患者预后较差，应加强病情监护。
目的：探討腦挫裂傷患者髮生進展性腦挫裂傷的高危因素及與預後的相關性。方法：收集在浙江蕭山醫院就診的腦挫裂傷病例共132例，按是否髮生進展性腦挫裂傷分為進展性腦挫裂傷組（70例）與非進展性腦挫裂傷組（62例），對相關危險因素進行單因素分析和多因素Logistic迴歸分析，併比較兩組患者6箇月的預後。結果：單因素分析結果顯示入院時格拉斯哥昏迷評分（ GCS ）、首次顱腦CT檢查顯示腦挫裂傷體積、中線移位、閤併有顱骨骨摺、蛛網膜下腔齣血、硬膜外血腫、硬膜下血腫、2型糖尿病及腦挫裂傷部位、血清D－二聚體水平是進展性腦挫裂傷的影響因素。多因素Logistic迴歸分析結果顯示GCS、首次顱腦CT檢查顯示腦挫裂傷體積、閤併蛛網膜下腔齣血、閤併2型糖尿病是進展性腦挫裂傷的獨立危險因素，進展性腦挫裂傷患者預後更差（ P＜0．01）。結論：意識障礙、腦挫裂傷範圍大、閤併有蛛網膜下腔齣血及2型糖尿病是進展性腦挫裂傷的高危因素，此類患者預後較差，應加彊病情鑑護。
목적：탐토뇌좌렬상환자발생진전성뇌좌렬상적고위인소급여예후적상관성。방법：수집재절강소산의원취진적뇌좌렬상병례공132례，안시부발생진전성뇌좌렬상분위진전성뇌좌렬상조（70례）여비진전성뇌좌렬상조（62례），대상관위험인소진행단인소분석화다인소Logistic회귀분석，병비교량조환자6개월적예후。결과：단인소분석결과현시입원시격랍사가혼미평분（ GCS ）、수차로뇌CT검사현시뇌좌렬상체적、중선이위、합병유로골골절、주망막하강출혈、경막외혈종、경막하혈종、2형당뇨병급뇌좌렬상부위、혈청D－이취체수평시진전성뇌좌렬상적영향인소。다인소Logistic회귀분석결과현시GCS、수차로뇌CT검사현시뇌좌렬상체적、합병주망막하강출혈、합병2형당뇨병시진전성뇌좌렬상적독립위험인소，진전성뇌좌렬상환자예후경차（ P＜0．01）。결론：의식장애、뇌좌렬상범위대、합병유주망막하강출혈급2형당뇨병시진전성뇌좌렬상적고위인소，차류환자예후교차，응가강병정감호。
Obejctive: To investigate the risk factors of progressive brain contusion and to evaluate their impact on patients’outcome.Methods: One hundred and thirty two patients with traumatic brain contusion were enrolled in the study , including 70 cases with progressive contusion and 62 cases with non-progressive contusion.The risk factors were investigated with univariate and multivariate Logistic regression analysis . Results: The univariate analysis showed that Glasgow Coma Score ( GCS ) at admission, contusion volume at the first brain CT scans, midline shift, combined with skull fracture, subarachnoid hemorrhage, epidural hematoma, subdural hematoma, location of brain contusion, D-dimer levels, combined with type 2 diabetes were associated with progressive brain contusion.Multivariate Logistic regression analysis showed that GCS at admission, contusion volume at the first CT scans, combined with subarachnoid hemorrhage, combined with type 2 diabetes were the independent risk factors for disease progression.The outcome in the progressive group was more aggravated than that in non-progressive group( P=0.001) .Conclusion:Patients with disturbance of consciousness, the larger contusion volume, combined with subarachnoid hemorrhage and diabetes are at risk for progressive brain contusion and unfavorable outcome.
