张学菊-中重型颅脑损伤患者继发脑梗死的相关因素及护理对策重点解读.doc

中重型颅脑损伤患者继发脑梗死的相关因素分析及护理对策 张学菊 滕州市中心人民医院 急诊科 277500 【摘要】目的 探讨中重型颅脑损伤患者继发脑梗死（TCI）的相关因素并总结护理对策。方法 585例中重型颅脑损伤患者，按照是否发生TCI分为TCI组和非TCI组，回顾性分析两组患者的临床资料，采用多元Logistic回归分析其危险因素。结果 TCI 57例，占9.74%，单因素分析结果显示，年龄、GCS评分、脑挫裂伤、合并伤、硬膜下血肿、蛛网膜下腔出血、脑疝及低血压均会显著影响TCI的发生及发展（P＜0.05）。多元Logistic回归分析结果显示，脑疝、低血压及GCS评分低是TCI发生的独立危险因素。结论 临床应高度关注TCI的各项危险因素，关注高危患者，监测颅内压，采用正确体位，合理的输液方式以及各项护理措施，维持患者脑灌注压，降低TCI的发生率。 【关键词】中重型颅脑损伤；继发脑梗死；相关因素；护理 The related factors of secondary cerebral infarction and nursing in patients with moderate and severe craniocerebral injury ZHANG Xue ju Emergency department of Tengzhou Central Peoples Hospital 277500 【Abstract】 Objective To investigate the related factors of secondary traumatic cerebral infarction (TCI) and nursing in patients with moderate and severe craniocerebral injury. Methods 585 cases of moderate and severe craniocerebral injury patients were divided into TCI group and non TCI group according to whether TCI occurred. The clinical data of two groups was analyzed with multivariate Logistic regression to screen the risk factors. Results There were 57 cases in TCI group accounted for 9.74%. Single factor analysis showed that age, GCS scores, brain contusion and laceration, associated injury, subdural hematoma, subarachnoid hemorrhage, cerebral hernia and hypotension will significantly influence the occurrence and development of TCI (P 0.05). Multivariate logistic regression analysis showed, cerebral hernia, hypotension and low GCS score were independent risk factors of TCI occurrence. Conclusion Close attention should be paid on high-risk patients, intracranial pressure monitoring, correct posture, reasonable infusion method and nursing measures should be used to maintain cerebral perfusion pressure and reduce the incidence of TCI. 【Key words】Moderate and severe craniocerebral injury; Traumatic cerebral infarction; Related factors; Nursing 继发脑梗死（TCI）是中重型颅脑损伤患者临床常见的并发症之一，是影响颅脑损伤患者预后的重要因素。TCI的出现不但会加重原有损伤，还会诱发新的脑损伤，致死率高达45%[1]。由于TCI的临床症状较为隐匿，容易与颅脑损伤相混淆，