儿童急性硬膜下血肿继发大面积脑梗死危险因素分析
Analysis of risk factors of massive cerebral infarction after craniocerebral injury in children with acute subdural hematoma
司玥 1李玉骞 1李虎 2杨阳 1李林怿 3邵永祥 4李立宏1
作者信息
- 1. 中国人民解放军空军军医大学唐都医院急诊科(西安 710032)
- 2. 宝鸡高新医院神经外科
- 3. 中国人民解放军空军军医大学卫勤训练基地卫生勤务教研室
- 4. 中国人民解放军空军军医大学西京医院
- 折叠
摘要
目的 分析急性硬膜下血肿(acute subdural hematoma,ASDH)术后继发大面积脑梗死患儿的临床表现和影像学特征,评估其潜在危险因素,为ASDH术后继发大面积脑梗死的预防、早期诊断和治疗提供依据.方法回顾性研究4～12岁ASDH患儿的临床资料,所有患儿接受常规手术治疗.创伤后继发大面积脑梗死(massive cere-bral infarction,MCI)是基于CT影像上低密度区域及临床体征诊断.回顾与患者预后相关的临床和影像学表现并进行统计学比较.采用多因素Cox回归分析对术后MCI进行初步评价,得出影响MCI的因素.结果 共纳入病例 67 例,32例列入MCI组,非MCI组35例.两组年龄(t= 2.016,P=0.048)、体质量(t=2.389,P=0.020)、多发伤(χ2 = 11.121,P=0.001)、GCS(Z=-4.730,P＜0.001)、血肿体积(χ2=12.890,P=0.002)、中线偏移度(mid-line shift,MLS;χ2 = 12.261,P= 0.002)及围手术期休克(χ2 =14.417,P＜0.001)差异具有统计学意义.GCS(OR=0.322,P= 0.002)、围手术期休克(OR =10.992,P =0.007)、多发伤(OR=6.547,P=0.046)与MLS(OR=46.974,P=0.025)是ASDH患儿发生MCI的主要风险因素.结论 围手术期休克、合并多发伤、GCS低评分和MLS大于10 mm是MCI的危险因素.具有多种危险因素的患儿MCI发生率显著提高.
Abstract
Objective To analyze and compare the clinical manifestations and imaging features of children with secondary massive cerebral infarction after acute subdural hematoma(ASDH),and to evaluate its potential risk factors in order to provide evidence for the prevention,early diagnosis and early treatment of secondary massive cerebral infarction after ASDH.Methods The clinical data of children with ASDH aged 4～12 years were retrospectively studied.All the children received routine operation.The diagnosis of post-traumatic secondary massive cerebral infarction(MCI)was based on low-density areas on CT images and clinical signs.Clinical and radiographic findings related to patient outcomes were reviewed and statistically compared.Univariate and multifactor Cox regression analysis was used to evaluate the MCI after operation to obtain the factors affecting MCI.Results A total of 67 cases were included in the study,with 32 cases included in the MCI group and 35 cases included in the non-MCI group.There were significant differences between MCI and non-MCI groups in age(t=2.016,P= 0.048),body mass(t=2.389,P=0.020),multiple injuries(χ2=11.121,P=0.001),GCS(Z=-4.730,P＜0.001),hematoma volume(χ2=12.890,P=0.002),MLS(χ2=12.261,P=0.002)and perioperative shock(χ2= 14.417,P＜0.001).GCS(OR=0.322,P=0.002),perioperative shock(OR=10.992,P=0.007),multiple injury(OR= 6.547,P=0.046)and MLS score(OR= 46.974,P=0.025)were major risk factors for MCI in children with ASDH.Conclusion Perioperative shock,multiple injuries,low GCS and MLS greater than 10mm are risk factors for MCI.The incidence of MCI is significantly increased in children with multiple risk factors.
关键词
急性硬膜下血肿/创伤性颅脑损伤/创伤后继发脑梗死/儿童/大面积脑梗死/危险因素Key words
Acute subdural hematoma/Traumatic brain injury/Secondary cerebral infarction after craniocerebral injury/Children/Massive cerebral infarction/Risk factor引用本文复制引用
出版年
2024
NETL
NSTL
万方数据