摘要
目的探讨创伤性进展性颅内血肿(PHI)的发病机制、相关危险因素以及早期诊治措施。方法对476例颅脑外伤患者发生PHI的危险因素(性别、年龄、入院时GCS评分、血糖、凝血功能、血压、血肿部位、血肿类型、血肿体积、是否合并SAH)进行回顾性分析。结果本组资料中发生PHI 68例,Logistic回归分析表明,患者年龄(P=0.019)以及是否合并蛛网膜下腔出血(SAH,P=0.008)为影响创伤后颅内血肿扩大的独立危险因素,且与PHI的发生率呈显著正相关(P<0.01)。预后按照GOS评分,恢复良好47例,轻残7例,重残5例,植物生存4例,死亡5例。结论进展性颅内血肿的发生与患者的年龄、是否合并SAH密切相关;伤后严密观察意识状态、动态复查CT、使用无创颅内压监护有助于早期发现PHI,首次CT扫描后4小时内复查CT是早期发现PHI的关键时间。
Objective To investigate the pathogenesis,risk factors and treatment of progressive hemorrhagic injury （PHI） after traumatic brain injury. Method A retrospective analysis was made on the risk factors of 476 cases with traumatic intracranial haematoma including gender, age, admission GCS score, blood glucose, coagulation, blood pressure, H ematoma location, hematoma types, hematoma volume, and whether combined subarachnoid hemorrhage. Results PHI occurred in 68 cases. Logistic regression analysis showed that Patient age （P=0. 019）, and whether combined subarachnoid hemorrhage （P=0. 008） were independent risk factors affecting the expansion of traumatic intracranial hematoma, which showed a significant positive correlation with the incidence of PHI. According to GOS classification, 47 cases were good recovery, 7 cases were mild disability, 5 cases were severe disability, 4 cases were plant survival of and 5 cases died. Conclusion The occurrence of PHI is closely related with the age and subaraehnoid hemorrhage. Close observation of the state of consciousness, dynamic review of CT, the use of noninvasive intracranial pressure monitoring can contrib- ute to the early diagnosis. The prime time of Early detection of hematoma is within 4 hours after the first CT scanning.
出处
《西部医学》
2014年第12期1617-1619,1622,共4页
Medical Journal of West China
基金
四川省卫生厅科研课题(110610)
关键词
颅脑损伤
进展性出血性损伤
手术治疗
Traumatic brain injury
Progressive hemorrhagic injury
Operation
