RESUMEN
Objective To investigate the in-hospital death-related factors for acute encephalocele in patients with craniocerebral injury for craniotomy in order to provide evidence for clinical treatment and prognosis determina-tion.Methods The clinical data of 105 patients with craniocerebral injury occurring acute encephalocele during cra-niotomy were analyzed retrospectively.The correlations of the factors including sex,age,preoperative Glasgow coma scale(GCS)scores,preoperative intracranial pressure(ICP),postoperative pupil status,causes of encephalocel,post-operative GCS scores,postoperative ICP,coagulation mechanism,brain swelling,preoperative hypoxia,preoperative blood pressure and blood glucose were analyzed.Results The prognosis was assessed according to the Glasgow out-come scale(GOS)scores after procedure.There were 77 patients in death group(namely death cases)and 28 patients in survival group.Logistic regression analysis showed that postoperative GCS scores (Wald =14.127,Exp(B)=0.044,95%CI:0.032,0.448),causes of encephalocel(Wald =7.748,Exp(B)=8.183,95%CI:1.825,10.251), postoperative ICP(Wald =7.637,Exp(B)=7.637,95% CI:1.969,8.028),postoperative pupil status(Wald =4.001,Exp(B)=2.499,95%CI:1.019,5.122)and blood glucose(Wald =7.915,Exp(B)=8.891,95% CI:1.790,9.337)were closely associated with the in-hospital death in patients with acute encephalocele in craniocere-bral injury operation(P <0.05).Conclusion The postoperative GCS scores,causes of encephalocel,postoperative ICP,postoperative pupil status and blood glucose could be used as the important indexes for predicting in-hospital death of acute encephalocele in craniocerebral injury for craniotomy.To prevent the intraoperative encephalocele and reduce the intracranial pressure are the important measures to reduce the mortality rate of the patients with acute encephalocele.
RESUMEN
Objective To study the risk factors of progressive cerebral contusion and laceration in patients with brain contusion and laceration,and to analyze the correlation between the prognosis of brain contusion and lacera-tion.Methods 128 patients with cerebral contusion and laceration were selected,and the patients were divided into the progress group (68 cases)and the non progress group (60 cases)according to the results of CT examination in 24h.Application of single factor and multiple factor Logistic regression analysis to analyze the risk factors of progres-sive cerebral contusion and laceration.And analyzed the related factors of the prognosis of patients.Results The admission GCS score,site of injury,cerebral contusion and laceration of volume,midline shift,with a skull fracture, complicated with subarachnoid hemorrhage,complicated with subdural hematoma,diabetes mellitus and D dimer level in the progress group and non progress group were significantly different (χ2 =9.336,P =0.009;χ2 =18.486,P =0.001;t =2.889,P =0.000;t =2.684,P =0.015;χ2 =16.164,P =0.000;χ2 =10.824,P =0.001;χ2 =8.667, P =0.003;χ2 =8.667,P =0.003;χ2 =10.824,P =0.001;t =2.842,P =0.000).Patients were followed up for 6 months,the mortality rate of the progress group was 11.76%,which was significantly higher than 1.67% in the non progress group (χ2 =4.972,P =0.026).Logistic regression analysis showed that admission GCS score,injury loca-tion,cerebral contusion and laceration of volume,complicated with subarachnoid hemorrhage,diabetes mellitus and D dimer level were risk factors of cerebral contusion and fracture trauma patients occurred in brain contusion and lacera-tion (OR =0.128,1.894,0.187,37.324,42.974,1.224,P =0.014,0.010,0.028,0.018,0.008,0.042,all P <0.05).Logistic regression analysis showed that the GCS score,the site of injury,the volume of brain contusion,the combination of subarachnoid hemorrhage and progressive brain contusion and laceration of brain contusion and lacera-tion were the prognostic factors (OR =0.133,1.124,0.208,34.321,41.964,P =0.018,0.014,0.025,0.018, 0.005,all P <0.05 ).Conclusion Admission GCS score,injury location,cerebral contusion and laceration of volume,complicated with subarachnoid hemorrhage,diabetes mellitus and D dimer level are risk factors of cerebral contusion and laceration happened progressive cerebral contusion and laceration,admission GCS score,site of injury, cerebral contusion and laceration of volume,complicated with subarachnoid hemorrhage and progressive cerebral con-tusion and laceration of brain contusion and laceration of prognostic factors,clinical should pay more attention to it.