Please wait a minute...
浙江大学学报（医学版）
浙江大学学报（医学版）  2015, Vol. 44 Issue (4): 410-416    DOI: 10.3785/j.issn.1008-9292.2015.07.10
原著     
进展性脑挫裂伤危险因素及与预后关系的分析
王科, 赵冬青, 张建军, 李玉健, 张海栋, 沈张锋, 胡兵, 吴海滨
浙江萧山医院神经外科, 浙江 杭州 311201
Risk factors of progressive brain contusion and relationship with outcome
WANG Ke, ZHAO Dong-qing, ZHANG Jian-jun, LI Yu-jian, ZHANG Hai-dong, SHEN Zhang-feng, HU Bin, WU Hai-bin
Department of Neurosurgery, Zhejiang Xiaoshan Hospital, Hangzhou 311201, China
全文: PDF(974 KB)  
摘要: 

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.
关键词 ： 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    
Abstract：

Objective: 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.
Key words： Glasgow Coma Score    Craniocerebral trauma/mortality    Craniocerebral trauma/epidemiology    Cause of death    Risk factors    Subarachnoid hemorrhage    Diabetes mellitus, type 2    Prognosis
收稿日期: 2015-01-04
CLC:  R651  
基金资助:

杭州市卫生科技计划(2013B54)
作者简介: 王科(1976-),男,硕士,副主任医师,主要从事颅脑外伤及脑血管病的临床研究,E-mail:wangke1st@126.com;http://orcid.org//0000-0003-4979-4326
服务　　
把本文推荐给朋友
加入引用管理器
E-mail Alert
RSS
作者相关文章　　

引用本文:

王科等. 进展性脑挫裂伤危险因素及与预后关系的分析[J]. 浙江大学学报（医学版）, 2015, 44(4): 410-416.
WANG Ke, ZHAO Dong-qing, ZHANG Jian-jun, LI Yu-jian, ZHANG Hai-dong, SHEN Zhang-feng, HU Bin, WU Hai-bin. Risk factors of progressive brain contusion and relationship with outcome. Journal of ZheJiang University(Medical Science), 2015, 44(4): 410-416.

链接本文:

http://www.zjujournals.com/xueshu/med/CN/10.3785/j.issn.1008-9292.2015.07.10      或      http://www.zjujournals.com/xueshu/med/CN/Y2015/V44/I4/410

[1] TAGLIAFERRI F, COMPAGNONE C, KORSICM M, et al. A systematic review of brain injury epidemiology in Europe[J]. Acta Neurochir(wien), 2006,148(3):255-268.
[2] FEIGIN V L, THEADOM A, BARKER-COLLO S, et al. Incidence of traumatic brain injury in New Zealand: a population-based study[J]. Lancet Neurol, 2013,12(1):53-64.
[3] 马定军,刘佰运,郝淑煜,等. 颅脑创伤数据库平台的建立与初步应用[J].中华神经外科杂志,2014,30(2):159-161. MA Ding-jun, LIU Bai-yun, HAO Shu-yu, et al. Establishment of database platform in traumatic brain injury field and its preliminary application[J]. Chinese Journal of Neurosurgery, 2014,30(2):159-161. (in Chinese)
[4] KURLAND D, HONG C, AARABI B, et al. Hemorrhagic progression of a contusion after traumatic brain injury: a review[J]. J Neurosurg, 2012,29(1):19-31.
[5] ALAHMADI H, VACHHRAJANI S, CUSIMANO M D. The natural history of brain contusion: an analysis of radiological and clinical progression[J]. J Neurosurg, 2010,112(5):1139-1145.
[6] ALLARD C B, SCARPELINI S, RHIND S G, et al. Abnormal coagulation tests are associated with progression of traumatic intracranial hemorrhage[J]. J Trauma, 2009,67(5):959-967.
[7] SON S, YOO C J, LEE S G, et al. Natural course of initially non-operated cases of acute subdural hematoma: the risk factors of hematoma progression[J]. J Korean Neurosurg, 2013,54(3):211-219.
[8] 李雪元,马 林,王新军,等. 急性颅脑损伤后进展性出血性损伤高危因素分析[J].重庆医学,2014,43(8):915-917. LI Xue-yuan, MA Lin, WANG Xin-jun, et al. Evaluation on the related high-risk factors of progressive hemorrhagic injury after acute traumatic brain injury[J]. Chongqing Medicine, 2014,43(8):915-917.(in Chinese)
[9] 王忠诚, 张玉琪. 王忠诚神经外科学[M]. 第2版,武汉:湖北科学技术出版社,2015:397-399. WANG Zhong-cheng, ZHANG Yu-qi. WANGZHONGCHENG Neurosurgery[M]. 2nd Ed. Wuhan: Hubei Science and Technology Press, 2015:397-399. (in Chinese)
[10] KOTHARI R U, BROTT T, BRODERICK J P, et al. The ABCs of measuring intracerebral hemorrhage volumes[J]. Stroke, 1996, 27(8):1304-1305.
[11] JURATLI T A, ZANG B, LITZ R J, et al. Early hemorrhagic progression of traumatic brain contusions: frequency, correlation with coagulation disorders, and patient outcome: a prospective study[J]. J Neurotrauma, 2014,31(17):1521-1527.
[12] DOUGHT R G. Posttraumatic delayed intracerebral hemorrhage[J]. South Med J, 1938,31(3):254-256.
[13] GUDEMAN S K, KISHORE P R, MILLER J D, et al. The genesis and significance of delayed traumatic intracerebral hematoma[J]. Neurosurgery, 1979,5(3):309-313.
[14] KAPLAN M, OZVEREN M F, TOPSAKAL C, et al. Asymptomatic interval in delayed traumatic intracerebral hemorrhage: report of two cases[J]. Clin Neurol Neurosurg, 2003,105(3):153-155.
[15] HORIUCHI T, NAKAGAWA F, MIYATAKE M, et al. Traumatic middle cerebral artery aneurysm: case report and review of the literature[J]. Neurosurg Rev, 2007,30(3):263-267.
[16] YANG T C, LO Y L, HUANG Y C, et al. Traumatic anterior cerebral artery aneurysm following blunt craniofacial trauma[J]. Eur Neurol, 2007,58(4):239-245.
[17] OERTEL M, KELLY D F, MCARTHUR D, et al. Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury[J]. J Neurosurg, 2002,96(1):109-116.
[18] KURLAND D, HONG C, AAREBI B, et al. Hemorrhagic progression of a contusion after traumatic brain injury: a review[J]. J Neurotrauma, 2012,29(1):19-31.
[19] WHITE C L, GRIFFITH S, CARON J L. Early progression of traumatic cerebral contusion: characterization and risk factors[J]. J Trauma, 2009,67(3):508-515.
[20] YUAN F, DING J, CHEN H, et al. Predicting progressive hemorrhage injury after traumatic brain injury: derivation and validation of a risk score based on admission characteristics[J]. J Neurotrauma,2012,29(12):2137-2142.
[21] ROOF R L, HALL E D. Gender differences in acute CNS trauma and stroke: neuroprotective effects of estrogen and progesterone[J]. J Neurotrauma,2000,17(5):367-388.
[22] IACCARINO C, SCHIAVI P, PICETTI E, et al. Patients with brain contusion: predictors of outcome and relationship between radiological and clinical evolution[J]. J Neurosurg, 2014,120(4):908-918.
[23] AMANDA M, LAIRD M D, PRESTON R, et al. Relationship of early hyperglycemia to mortality in trauma patients[J]. J Trauma, 2004,56(5):1058-1062.
[24] MARMAROU A, LU J, BUTCHER I, et al. Prognostic value of the Glasgow Coma Scale and pupil reactivity in traumatic brain injury assessed pre-hospital and on enrollment: an IMPACT analysis[J]. J Neurotrauma, 2007,24(2):270-280.
[25] WURMB T E,SCHLERETH S,KREDEL M,et al. Routine follow-up cranial computed tomography for deeply sedated, intubated, and ventilated multiple trauma patients with suspected severe head injury[J]. Biomed Res Int, 2014,2014:361949.
[26] JOSEPH B, AZIZ H, PANDIT V, et al. A three-year prospective study of repeat head computed tomography in patients with traumatic brain injury[J]. J Am Coll Surg, 2014,219(1):45-51.
[27] DE REUCK J. Risk factors for late-onset seizure related to cerebral contusions in adults with a moderate traumatic brain injury[J]. Clin Neurol Neruosurg, 2011,113(6):469-471.
[28] 沈合春,钱志远,郑达理,等. 急性颅脑损伤后进展性出血性损伤极高危因素分析及定时复查CT时间探讨[J].中华神经医学杂志, 2011,10(7):735-740. SHEN He-chun, QIAN Zhi-yuan, ZHENG Da-li, et al. High-risk factors of progressive hemorrhagic injury after acute traumatic brain injury and its time for first scheduled brain CT[J]. Chinese Journal of Neuromedicine, 2011,10(7):735-740. (in Chinese)
[29] LEUNG G K, NG G K, HO W, et al. Impact of a multidisciplinary trauma team on the outcome of acute subdural haematoma[J]. Injury, 2012,43(9):1419-1422.
[30] TONG W S, ZHENG P, XU J F, et al. Early CT signs of progressive hemorrhagic injury following acute traumatic brain injury[J]. Neuroradiology, 2011,53(5):305-309.
[31] LEUNG G K, NG G K, HO W, et al. Impact of a multidisciplinary trauma team on the outcome of acute subdural haematoma[J]. Injury, 2012,43(9):1419-1422.
[32] HARHANGI B S, KOMPANJE E J, LEEBEEK F W, et al. Coagulation disorders after traumatic brain injury[J]. Acta Neurochir(Wien), 2008,150(2):165-175.
[33] HALPERN C H, REILLY P M, TURTZ A R, et al. Traumatic coagulopathy: the effect of brain injury[J]. J Neurotrauma, 2008,25(8):997-1001.
[34] COHEN M J, BROHI K, GANTER M T, et al. Early coagulopathy after traumatic brain injury: the role of hypoperfusion and the protein C pathway[J]. J Trauma, 2007,63(6):1254-1261.
[1] 蔡成,王建平,钟志凤,戴志慧,王庆华,董武真,施红旗,刘庆伟,杜金林. 缺氧诱导因子1α和CD133预测直肠癌患者新辅助放化疗疗效的临床研究[J]. 浙江大学学报（医学版）, 2017, 46(1): 36-43.
[2] 杨肃文 等. 意义未明单克隆免疫球蛋白病及多发性骨髓瘤患者微RNA-221和微RNA-222的表达[J]. 浙江大学学报（医学版）, 2016, 45(4): 371-378.
[3] 姚美芳 等. 2型糖尿病患者合并代谢综合征增加Framingham心血管危险评分[J]. 浙江大学学报（医学版）, 2016, 45(3): 268-274.
[4] 边薇 等. 临时血液透析对维持性腹膜透析患者生存预后的影响[J]. 浙江大学学报（医学版）, 2016, 45(2): 195-200.
[5] 徐芳英 等. 神经内分泌分化在胃腺癌进展及患者预后中的意义[J]. 浙江大学学报（医学版）, 2016, 45(1): 24-30.
[6] 杨婉花等. MicroRNA-150联合脉搏指示连续性心输出量检测指标判断脓毒症休克患者预后的临床价值[J]. 浙江大学学报（医学版）, 2015, 44(6): 659-664.
[7] 严慎强等. 既往抗血小板治疗对合并颅内微出血急性缺血性卒中患者静脉溶栓的安全性分析[J]. 浙江大学学报（医学版）, 2015, 44(6): 618-624.
[8] 张建民. 动脉瘤性蛛网膜下腔出血诊治热点问题及展望[J]. 浙江大学学报（医学版）, 2015, 44(4): 357-360.
[9] 闫伟等. 经翼点小骨窗入路治疗前循环颅内动脉瘤患者临床疗效分析[J]. 浙江大学学报（医学版）, 2015, 44(4): 366-370.
[10] 黄学才等. 高渗盐水和甘露醇在动脉瘤性蛛网膜下腔出血患者降低颅内压中的应用[J]. 浙江大学学报（医学版）, 2015, 44(4): 389-395.
[11] 席晓平, 曾令霞, 余方方, 刘华胜. DNMT3A基因突变对急性髓系白血病预后影响的meta分析[J]. 浙江大学学报（医学版）, 2015, 44(2): 197-203.
[12] 严晓波, 张圣, 严慎强, 楼敏. 不同严重程度急性缺血性卒中患者静脉溶栓预后的影响因素分析[J]. 浙江大学学报（医学版）, 2015, 44(1): 54-60.
[13] 吴健，等. 原发性肝癌自发性破裂的预测模型构建[J]. 浙江大学学报（医学版）, 2014, 43(6): 652-657.
[14] 刘建华，等. 瞬时弹性成像预测肝移植受者近期预后[J]. 浙江大学学报（医学版）, 2014, 43(6): 678-682.
[15] 程龙宇, 等. 成人肝移植后发生持续性血小板减少的危险因素分析及其预防措施探讨[J]. 浙江大学学报（医学版）, 2014, 43(6): 670-677.