影响脑外伤致硬膜外血肿患者预后的多因素Logistic回归分析
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摘要
目的探讨影响脑外伤致硬膜外血肿患者近期预后的相关因素。方法回顾分析在本院接受开颅手术治疗的170例脑外伤致硬膜外血肿患者的临床资料,观察患者近期预后情况,并采用Logistic回归分析法对可能影响患者预后的因素进行分析。结果 170例脑外伤致硬膜外血肿患者经手术治疗后,死亡9例(5. 29%),植物生存10例(5. 88%),重度残疾19例(11. 18%),不良预后总发生率为22. 35%(38/170)。单因素分析得出不良预后发生率在年龄、瞳孔改变、受伤后距离手术时间、术前GCS评分、血肿量、手术方式、合并颅内其它损伤、并发症中的差异有统计学意义(P <0. 05);多因素Logistic回归分析得出年龄≥60岁、瞳孔改变、受伤后距离手术时间≥12 h、合并颅内其它损伤是影响患者预后的危险因素(P <0. 05),术前GCS评分≥9分是影响患者预后的保护因素(OR=1. 507,P <0. 05)。结论高龄、瞳孔发生变化、受伤后距离手术时间超过12 h、术前GCS评分偏低、合并有其它颅内损伤均会增加脑外伤致硬膜外血肿患者术后残疾或死亡的发生风险。
Objective The related factors of short-term prognosis in patients with traumatic brain hematoma caused by epidural hematoma were investigated. Methods The clinical data of 170 patients with epidural hematoma caused by craniotomy in our hospital were analyzed retrospectively. The short-term prognosis was observed and the factors affecting the prognosis of patients were analyzed by Logistic regression analysis. Results Among 170 cases of epidural hematoma due to traumatic brain injury,9 cases(5. 29%) were died,10 cases(5. 88%) were planted,19 cases(11. 18%) were severe disability,and the total incidence of adverse prognosis was 22. 35%(38/170).Univariate analysis showed that there were significant differences in the incidence of poor prognosis among the age,pupil change,the time from the injury to the operation,pre-operative GCS score,hematoma volume,operation mode,other intracranial injury and complication(P <0. 05). Multivariate Logistic regression analysis showed that age over60 years old,pupil change,the time from the injury to the operation over 12 h,combining with other intracranial injury were the risk factors affecting the prognosis(P <0. 05),and pre-operative GCS score more than 9 points was the protective factor of the prognosis of patients(OR = 1. 507,P < 0. 05). Conclusion The advanced age,pupil changes,time from the injury to the operation over 12 h,low pre-operative GCS score,and combined with other intracranial injuries will increase the risk of disability or death in patients with epidural hematoma caused by traumatic brain injury.
Objective The related factors of short-term prognosis in patients with traumatic brain hematoma caused by epidural hematoma were investigated. Methods The clinical data of 170 patients with epidural hematoma caused by craniotomy in our hospital were analyzed retrospectively. The short-term prognosis was observed and the factors affecting the prognosis of patients were analyzed by Logistic regression analysis. Results Among 170 cases of epidural hematoma due to traumatic brain injury,9 cases(5. 29%) were died,10 cases(5. 88%) were planted,19 cases(11. 18%) were severe disability,and the total incidence of adverse prognosis was 22. 35%(38/170).Univariate analysis showed that there were significant differences in the incidence of poor prognosis among the age,pupil change,the time from the injury to the operation,pre-operative GCS score,hematoma volume,operation mode,other intracranial injury and complication(P <0. 05). Multivariate Logistic regression analysis showed that age over60 years old,pupil change,the time from the injury to the operation over 12 h,combining with other intracranial injury were the risk factors affecting the prognosis(P <0. 05),and pre-operative GCS score more than 9 points was the protective factor of the prognosis of patients(OR = 1. 507,P < 0. 05). Conclusion The advanced age,pupil changes,time from the injury to the operation over 12 h,low pre-operative GCS score,and combined with other intracranial injuries will increase the risk of disability or death in patients with epidural hematoma caused by traumatic brain injury.
引文
1 ZUCKERMAN S L,MORGAN C D,BURKS S,et al. Functional and structural traumatic brain injury in equestrian sports:a review of the literature[J]. World Neurosurg,2015,83(6):1098-1113.
2 寇堃,陈军,李爱民,等.外伤性进展性硬脑膜外血肿93例报告[J].实用临床医药杂志,2014,18(9):188-190.
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5 柏鲁宁,柯尊华,范小璇,等.外伤性进展性硬脑膜外血肿形成的相关因素[J].上海医学,2013,36(12):1028-1030.
6 杨金辉,张立贤,王海洋.脑外伤硬膜外血肿患者的临床治疗分析[J].转化医学电子杂志,2016,3(10):55-56.
7 SIASIOS I D, VAKHARIA K, GIBBONS K J, et al. Large,spontaneous spinal subdural-epidural hematoma after epidural anesthesia for caesarean section:conservative management with excellent outcome[J]. Surg Neurol Int,2016,7(Suppl 25):S664-S667.
8 周新军,徐豪,任力.合并其它脑损伤的急性硬膜外血肿术后颅内压监护[J].中华神经外科疾病研究杂志,2015,14(6):552-553.
2 寇堃,陈军,李爱民,等.外伤性进展性硬脑膜外血肿93例报告[J].实用临床医药杂志,2014,18(9):188-190.
3 LEITGEB J,MAURITZ W,BRAZINOVA A,et al. Outcome after severe brain trauma associated with epidural hematoma[J]. Arch Orthop Trauma Surg,2013,133(2):199-207.
4 郭灿,朱新洪,向海,等.神经外科颅脑外伤患者预后影响因素分析[J].中国医学工程,2014,22(1):29.
5 柏鲁宁,柯尊华,范小璇,等.外伤性进展性硬脑膜外血肿形成的相关因素[J].上海医学,2013,36(12):1028-1030.
6 杨金辉,张立贤,王海洋.脑外伤硬膜外血肿患者的临床治疗分析[J].转化医学电子杂志,2016,3(10):55-56.
7 SIASIOS I D, VAKHARIA K, GIBBONS K J, et al. Large,spontaneous spinal subdural-epidural hematoma after epidural anesthesia for caesarean section:conservative management with excellent outcome[J]. Surg Neurol Int,2016,7(Suppl 25):S664-S667.
8 周新军,徐豪,任力.合并其它脑损伤的急性硬膜外血肿术后颅内压监护[J].中华神经外科疾病研究杂志,2015,14(6):552-553.