摘要
目的探讨中、重型创伤性颅脑损伤并发外伤性颅内静脉窦闭塞（CVSO）的早期诊断方法及相关危险因素。 方法对2012年1月至2015年12月收治的212例中、重型创伤性颅脑损伤患者的临床资料进行回顾性分析，记录外伤性CVSO的发生情况，并对外伤性CVSO的相关危险因素进行统计分析。 结果颅脑损伤患者CVSO发生率为16.5%（35/212），其中血栓型CVSO（Ⅰ型）10例、压迫型CVSO（Ⅱ型）16例、混合型CVSO（Ⅲ型）9例。Logistic多因素回归分析提示跨静脉窦颅骨骨折、跨静脉窦硬膜外血肿均是导致外伤性CVSO的危险因素（OR= 8.141、3.179，95%CI：3.224~20.840、1.470~7.037，P〈0.05），其中跨静脉窦颅骨骨折与外伤性CVSO相关性最为显著。进一步行Logistic多分类回归分析，提示女性是导致发生Ⅰ型CVSO的危险因素（OR=10.425，95%CI：1.831~30.053），跨静脉窦硬膜外血肿是导致发生Ⅱ型CVSO的危险因素（OR=5.766，95%CI：1.885~18.197），跨静脉窦颅骨骨折、跨静脉窦硬膜外血肿、存在静脉血栓史均是导致发生Ⅲ型CVSO的危险因素（OR=18.005、4.596、11.394，95%CI：2.021~58.836、1.144~19.525、1.436~46.558）。 结论进行外伤性CVSO早期诊断时，应重点关注跨静脉窦颅骨骨折以及跨静脉窦硬膜外血肿，应辅以颅脑MR静脉造影或CT静脉造影检查，还需同时追问静脉血栓疾病史。
Objective To analyze the risk factors for traumatic cerebral venous sinus occlusion （CVSO）and to investigate the strategies of early diagnosis of traumatic CVSO. Methods The clinical data of 212 patients with moderate to severe closed traumatic brain injury from January 2012 to December 2015 were analyzed retrospectively. Logistic regression analysis was used to evaluate the risk factors for traumatic CVSO. Results Of the 212 patients with traumatic brain injury, 16.5%（35/212） patients had CVSO. Ten patients had CVSO of thrombotic type （type Ⅰ ）, 16 patients had CVSO of compression type （type Ⅱ ）, and 9 patients had CVSO of mixed type （type Ⅲ）. Logistic regression analysis showed that skull fracture （OR = 8.141; 95% CI： 3.224-20.840） and epidural hematoma of crossing venous sinus （OR = 3.179; 95% CI： 1.470 -7.037） were the risk factors for CVSO, and the former was more significantly correlated with CVSO. Female gender was the risk factor for CVSO type Ⅰ （OR = 10.425; 95% CI： 1.831- 30.053）, epidural hematoma of crossing venous sinus was the risk factor for CVSO type n （OR = 5.766; 95% CI： 1.885 -18.197）, and skull fracture, epidaral hematoma of crossing venous sinus, and the previous history of vein thrombosis was the risk factors for CVSO type Ⅲ （OR = 18.005, 4.596, 11.394; 95% CI： 2.021 -58.836, 1.144-19.525, 1.436-46.558）. Conclusions In the early diagnosis of traumatic CVSO, the crossing venous sinus fracture line and epidural hematoma should be given attention. Attention should be paid to the history of venous thrombosis. MR venography and CT venography contributes to early diagnosis of CVSO.
出处
《中国医师进修杂志》
2016年第12期1091-1094,共4页
Chinese Journal of Postgraduates of Medicine
基金
广东省中山市科技计划项目（2015B1279）
关键词
颅脑损伤
脑静脉
危险因素
早期诊断
Craniocerebral trauma
Cerebral veins
Risk factors
Early diagnosis
