颅脑损伤后急性硬膜下血肿预后相关因素的探讨.docVIP

颅脑损伤后急性硬膜下血肿预后相关因素的探讨 目录 TOC \o 1-9 \h \z \u 目录 1 正文 1 文1：颅脑损伤后急性硬膜下血肿预后相关因素的探讨 1 1 一般资料 2 2 治疗方案 3 3 统计学处理 3 1 患者死亡、功能恢复与影响因素的组间差异影响 3 2 患者死亡率增加的主要影响因素 4 3 患者功能恢复的主要影响因素 4 文2：急性硬膜下血肿预后相关因素的探讨 6 1 资料和方法 7 2 结 果 8 3 讨 论 8 参考文摘引言： 9 原创性声明（模板） 12 文章致谢（模板） 12 正文 颅脑损伤后急性硬膜下血肿预后相关因素的探讨 文1：颅脑损伤后急性硬膜下血肿预后相关因素的探讨 Abstract： Objective To explore facto associated with prognosis in patients with acute subdural hematoma(ASDH).Methods The preoperative and postoperative data of 256 patients in our hospital who underwent surgical intervention for traumatic ASDH were related facto of prognosis were analyzed by using multivariate logistic regression Functional recovery was achieved in % of patients and the overall mortality was %.Age,pupillary abnormality,preoperative GCS score,and intraoperative acute brain swelling(ABS) were independent predicto for functional preoperative pupillary abnormality,GCS score,and intraoperative ABS were independent predicto for shift thickness,volume of hematoma,operation time following injury showed no independent association with functional recovery,although these variables were correlated with functional recovery in univariate Functional recovery is more likely to be achieved in patients who are under 40 yea old,and have preoperative reactive pupils,higher GCS score and the absence of ABS during surgery. Key words:brain injury;subdural hematoma;brain swelling 急性硬膜下血肿(ASDH)是临床上常见的颅脑损伤，多需要手术治疗，发生率为12%～30%，死亡率为36%～79%。近年来，虽然医疗条件不断改善并有颅内压监护治疗措施，但死亡率和致残率仍居高不下。本文回顾性总结我院2000年3月～2009年3月共256名ASDH患者术前及术后1个月临床资料，并应用logistic回归对影响预后的相关因素指标进行分析。 资料与方法 1 一般资料 本组256例，其中男性196例，女性60例;年龄14～84岁，平均岁。致伤原因：道路 交通 伤115例，坠落伤75例，打击伤40例，其他26例。合并硬膜外血肿95例，脑挫裂伤及脑内血肿175例，颅骨骨折130例，蛛网膜下腔出血230例。排除首次头颅CT提示硬膜外血肿需要手术患者、胸腹部合并伤患者、肝肾功能不全患者及糖尿病患者。 患者术后1个月按格拉斯哥预后评分(GOS评分)进行评价：GOS 1分，死亡;GOS 2分，植物状态;GOS 3分，严重残疾;GOS 4分，中度残疾;GOS 5分，恢复良好。GOS评分1～3分者为恢复不良组，4～5分者为恢复良好组。 2 治疗方案 所有患者入院后均给予完善术前检查，无禁忌证后给予手术治疗。手术方式及手术适应证及术后治疗均按照《 中国 颅脑损伤救治指南》执行，术后必要时给予气管切